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Title: Economic evaluation of the Melbourne Mobile Stroke Unit.
Austin Authors: Kim, Joosup;Easton, Damien;Zhao, Henry;Coote, Skye;Sookram, Garveeta;Smith, Karen;Stephenson, Michael;Bernard, Stephen;W Parsons, Mark;Yan, Bernard;Desmond, Patricia M;Mitchell, Peter J;Campbell, Bruce C V;Donnan, Geoffrey A ;Davis, Stephen M;Cadilhac, Dominique A
Affiliation: Department of Paramedicine, Monash University, Clayton, Australia
Ambulance Victoria, Blackburn North, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Australia
Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Department of Radiology, the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
Issue Date: 14-Jun-2020 2020-06-14
Publication information: International Journal of Stroke 2020; online first: 14 June
Abstract: The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.
DOI: 10.1177/1747493020929944
ORCID: 0000-0002-4079-0428
PubMed URL: 32536328
Type: Journal Article
Subjects: Economic evaluation
mobile Stroke unit
prehospital Stroke treatment
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