Cost-Effectiveness of Mobile Stroke Unit Care in Norway

Abstract

BACKGROUND: Acute ischemic stroke treatment in mobile stroke units (MSUs) reduces time-to-treatment and increases thrombolytic rates, but implementation requires substantial investments. We wanted to explore the cost-effectiveness of MSU care incorporating novel efficacy data from the Norwegian MSU study, Treat-NASPP (the Norwegian Acute Stroke Prehospital Project). METHODS: We developed a Markov model linking improvements in time-to-treatment and thrombolytic rates delivered by treatment in an MSU to functional outcomes for the patients in a lifetime perspective. We estimated incremental costs, health benefits, and cost-effectiveness of MSU care as compared with conventional care. In addition, we estimated a minimal MSU utilization level for the intervention to be cost-effective in the publicly funded health care system in Norway. RESULTS: MSU care was associated with an expected quality-adjusted life-year-gain of 0.065 per patient, compared with standard care. Our analysis suggests that about 260 patients with ischemic stroke need to be treated with MSU annually to result in an incremental cost-effectiveness ratio of about NOK385 000 (US$43 780) per quality-adjusted life-year for MSU compared with standard care. The incremental cost-effectiveness ratio varies between some NOK1 000 000 (US$113 700) per quality-adjusted life-year if an MSU treats 100 patients per year and to about NOK340 000 (US$38 660) per quality-adjusted life-year if 300 patients with acute ischemic stroke are treated. CONCLUSIONS: MSU care in Norwegian settings is potentially cost-effective compared with conventional care, but this depends on a relatively high annual number of treated patients with acute ischemic stroke per vehicle. These results provide important information for MSU implementation in government-funded health care systems.

We need mobile stroke units

“…En nylig helseøkonomisk analyse i samarbeid med Folkehelseinstitu et viser at slagambulansebehandling er potensielt kostnadseffektivt i områder der minst 125-260 pasienter kan behandles per slagambulanse per år (12). De e kan vaere realistisk flere steder i Norge (13), og rendezvous-metoden (møtekjøring med vanlig ambulanse) gjør at opptaksområdene kan utvides.…”

Cost-effectiveness of tenecteplase versus alteplase for stroke thrombolysis evaluation trial in the ambulance

“…Economic evaluations of the Melbourne MSU and other MSUs internationally have been previously reported. Three German, [23][24][25] Norwagian 26 and one US 27 study suggested that high costs can be averted in stroke acute care, but the cost-effectiveness was subject to the effectiveness of MSU, staff size, population density, etc. The incremental cost-effectiveness ratio of the Melbourne MSU, which the TASTE-a trial was based on, was very favourable at $30,982 per disability-adjusted life year avoided, falling below the often used willingness to pay per DALY threshold in Australia of AUD 50,000.…”

Mobile Stroke Units and Pursuit of Intravenous Tissue-Type Plasminogen Activator Treatment in the Golden Hour

“…Available cost-effectiveness studies from several countries have suggested that MSUs are generally cost-effective. [13][14][15][16] However, the conclusions of these analyses are heavily dictated by starting assumptions. The calculation of incremental cost-effectiveness ratios comparing MSUs with routine EMS care are affected by a large number of factors, which can vary widely between countries, regions, and systems (these include, eg, the organization of existing routine EMS services, costs of alternative MSU staffing models, size of the geographic region assessed, population density, underlying stroke incidence, and number of stroke patients treated by MSU).…”