Abstract
Background: Mobile stroke units (MSUs) are the latest approach to improving time-sensitive stroke care delivery. Currently, there are no published studies looking at the expanded value of the MSU to diagnose and transport patients to the closest most appropriate facility. The purpose of this paper is to perform a cost consequence analysis of standard transport (ST) vs. MSU.Methods and Results: A cost consequence analysis was undertaken within a decision framework to compare the incremental cost of care for patients with confirmed stroke that were served by the MSU vs. their simulated care had they been served by standard emergency medical services between July 2014 and October 2015. At baseline values, the incremental cost between MSU and ST was $70,613 ($856,482 vs. $785,869) for 355 patient transports. The MSU avoided 76 secondary interhospital transfers and 76 emergency department (ED) encounters. Sensitivity analysis identified six variables that had measurable impact on the model's variability and a threshold value at which MSU becomes the optimal strategy: number of stroke patients (>391), probability of requiring transfer to a comprehensive stroke center (CSC, >0.52), annual cost of MSU operations (<$696,053), cost of air transfer (>$8,841), probability initial receiving hospital is a CSC (<0.32), and probability of ischemic stroke with ST (<0.76).Conclusions: MSUs can avert significant costs in the administration of stroke care once optimal thresholds are achieved. A comprehensive cost-effectiveness analysis is required to determine not just the operational value of an MSU but also its clinical value to patients and the society.
Highlights
Delivering effective and timely care for patients experiencing stroke requires extensive and costly resources that are consolidated at comprehensive stroke centers (CSCs)
Previous studies have focused on the clinical benefits from earlier intervention provided by an Mobile stroke units (MSUs), mainly through the early administration of a tissue plasminogen activator [8]
Clinical probabilities were derived directly from the local patient population served by the MSU representing actual practice and a range of operational costs of the MSUs that are typically owned and operated by health systems—representing additional cost when compared to standard transport (ST) that is provided by local municipalities
Summary
Delivering effective and timely care for patients experiencing stroke requires extensive and costly resources that are consolidated at comprehensive stroke centers (CSCs). Many patients do not live in the primary catchment area of a CSC and may present first to a primary stroke center (PSC) or a less capable facility. For those patients requiring comprehensive stroke care, the need for Mobile Stroke Cost Consequence Analysis additional transfer to a CSC can result in substantial delays in the delivery of definitive treatment, leading to poorer outcomes and increased cost [1,2,3]. MSUs are prehospital ambulances that are fully equipped to perform patient assessments and diagnostic testing (point-of-care lab testing and computerized tomography/angiography) that are necessary to diagnose and initiate stroke treatment prior to transporting to the closest most appropriate facility. The purpose of this paper is to perform a cost consequence analysis of standard transport (ST) vs. MSU
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