eprintid: 35531
rev_number: 10
eprint_status: archive
userid: 3730
dir: disk0/00/03/55/31
datestamp: 2024-10-23 15:47:26
lastmod: 2024-11-05 15:05:37
status_changed: 2024-10-23 15:47:26
type: article
metadata_visibility: show
creators_name: Rink, Johann S
creators_name: Froelich, Matthias F
creators_name: Nour, May
creators_name: Saver, Jeffrey L
creators_name: Szabo, Kristina
creators_name: Hoyer, Carolin
creators_name: Fassbender, Klaus C
creators_name: Schoenberg, Stefan O
creators_name: Tollens, Fabian
title: Lifetime economic potential of mobile stroke units in acute stroke care: A model-based analysis of the drivers of cost-effectiveness
ispublished: pub
subjects: ddc-610
divisions: old-i-62700
note: Dieser Beitrag ist aufgrund einer (DFG-geförderten) Allianz bzw. Nationallizenz frei zugänglich. *** This publication is freely accessible due to an Alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.
abstract: Background and purpose: To simulate patient-level costs, analyze the economic potential of telemedicine-based mobile stroke units for acute prehospital stroke care, and identify major determinants of cost-effectiveness, based on two recent prospective trials from the United States and Germany.
Methods: A Markov decision model was developed to simulate lifetime costs and outcomes of mobile stroke unit. The model compares diagnostic and therapeutic pathways of ischemic stroke, hemorrhagic stroke, and stroke mimic patients by conventional care or by mobile stroke units. The treatment outcomes were derived from the B_PROUD and the BEST-mobile stroke unit trials and further input parameters were derived from recent literature. Uncertainty was addressed by deterministic and probabilistic sensitivity analyses. A lifetime horizon based on the US healthcare system was adopted to evaluate different cost thresholds for mobile stroke unit and the resulting cost-effectiveness. Willingness-to-pay thresholds were set at 1x and 3x gross domestic product per capita, as recommended by the World Health Organization.
Results: In the base case scenario, mobile stroke unit care yielded an incremental gain of 0.591 quality-adjusted life years per dispatch. Mobile stroke unit was highly cost-effective up to a maximum average cost of 43,067 US dollars per patient. Sensitivity analyses revealed that MSU cost-effectiveness is mainly affected by reduction of long-term disability costs. Also, among other parameters, the rate of stroke mimics patients diagnosed by MSU plays an important role.
Conclusion: This study demonstrated that mobile stroke unit can possibly be operated on an excellent level of cost-effectiveness in urban areas in North America with number of stroke mimic patients and long-term stroke survivor costs as major determinants of lifetime cost-effectiveness.
date: 2022-09
date_type: published
id_scheme: DOI
id_number: 10.11588/heidok.00035531
official_url: https://doi.org/10.1177/1357633X221140951
ppn_swb: 190762628X
own_urn: urn:nbn:de:bsz:16-heidok-355316
language: eng
bibsort: RINKJOHANNLIFETIMEEC20240909
full_text_status: public
publication: Journal of Telemedicine and Telecare
volume: 30
number: 8
place_of_pub: Sage Journals
pagerange: 1335-1344
pages: 10
issn: 1357-633X (Druck-Ausg.), 1758-1109 (Online-Ausg.)
edition: Zweitveröffentlichung
citation:   Rink, Johann S ; Froelich, Matthias F ; Nour, May ; Saver, Jeffrey L ; Szabo, Kristina ; Hoyer, Carolin ; Fassbender, Klaus C ; Schoenberg, Stefan O ; Tollens, Fabian  (2022) Lifetime economic potential of mobile stroke units in acute stroke care: A model-based analysis of the drivers of cost-effectiveness.  Journal of Telemedicine and Telecare, 30 (8).  pp. 1335-1344.  ISSN 1357-633X (Druck-Ausg.), 1758-1109 (Online-Ausg.)     
document_url: https://archiv.ub.uni-heidelberg.de/volltextserver/35531/1/10.1177_1357633X221140951.pdf