Mobile stroke units cost-effective, especially in patients with no baseline disability
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Mobile stroke units were found to be cost-effective for tissue plasminogen activator-eligible patients, especially for those with no baseline disability, a speaker reported.
According to an economic analysis of the BEST-MSU trial presented at the International Stroke Conference, mobile stroke units were found to not only be increasingly cost-effective as the number of patients treated increased, but were more cost-effective compared with standard management for patients with a baseline modified Rankin Scale score of 0 to 1.
“Starting and operating a mobile stroke unit is very expensive on a day-to-day basis, so we set out to understand if this high investment in the mobile stroke unit benefits patients, and if there are any downstream cost savings for the health system,” Suja S. Rajan, PhD, health economist and associate professor at the University of Texas School of Public Health, said during the presentation. “We compared mobile stroke unit patients and their outcomes with standard management to establish this economic evaluation ... given we’ve already established that the mobile stroke unit is clinically beneficial for patients and gets them treatment soon enough, we wanted to see if that translated to better quality of life downstream and cost savings downstream.”
The BEST-MSU trial was a multicenter randomized trial that evaluated 90-day functional outcomes of tissue plasminogen activator (tPA)-eligible patients managed by a mobile stroke unit compared with standard ambulance, with the two stroke management modalities being dispatched on alternating weeks.
As Healio previously reported, 33% of patients received tPA by mobile stroke unit within the first hour of symptom onset compared with 3% of those treated by standard ambulance, and mobile stroke unit treated-patients had better 90-day functional outcomes compared with those treated with standard care.
For the present economic analysis of the BEST-MSU trial, researchers collected 1 year of follow-up data from the mobile stroke unit population and, according to Rajan, are the first to do so. Follow-up data included health care resource utilization and quality of life assessed using European Quality of Life Five Dimension (EQ-5D). Researchers also gathered data on the cost of mobile stroke units over and above standard management, accounting for capital investment and operating costs.
Length of stay during index hospitalization for stroke and the proportion of patients discharged to home did not differ between those treated by a mobile stroke unit compared with standard management.
Rajan and colleagues noted that, during the 1-year follow-up, patients treated by mobile stroke unit had more days at home not requiring nursing home or rehospitalization compared with standard management (297 vs. 284). This finding was consistent within the subgroup of patients with no disability at baseline (327 vs. 310).
After collecting 1-year worth of 5-level EQ-5D data, researchers observed that patients treated by mobile stroke unit reported better average quality of life compared with those who received standard management (66.3 vs. 65.1).
In the subgroup analysis isolated to those with no disability at baseline, researchers saw even greater improvement in quality of life among patients treated by mobile stroke unit compared with standard management.
In the unadjusted analysis evaluating total downstream costs of health care utilization for all causes, mobile stroke units were found to be more expensive than standard care ($57,658 vs. $54,898). Overall cost was reduced when the analysis was restricted to only stroke-related costs ($42,045 vs. $42,229); however, when the analysis was restricted even further to patients with no baseline disability, mobile stroke units were found to be slightly less expensive compared with standard management ($38,181 vs. $38,999).
The researchers estimated that the total annual additional capital and operating cost of a mobile stroke unit was $436,457.
According to the presentation, the incremental cost-effectiveness ratio (ICER) for an intervention to be determined as cost-effective in the U.S. can vary between $50,000 and $190,000 per quality-adjusted life-year.
Researchers observed that mobile stroke units were associated with an ICER of $33,537 per QALY for all stroke patients and $10,740 for patients with no baseline disability.
Rajan added that the cost-effectiveness of interventions with high capital investment is dependent on the number of patients treated per year.
Using the $190,000 threshold for cost-effectiveness, as recommended by WHO based on U.S. gross domestic product, the number needed to treat of tPA-eligible patients was between 100 and 150 per year, and approximately 50 per year when restricted to individuals with no baseline disability.
“Focusing mostly on the stroke-related costs, the mobile stroke unit is cost-effective, especially if we restrict our sample to just patients with no baseline disability. Cost-effectiveness improves based on the number of patients we treat per year,” Rajan said.
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Rajan SS. LB4. Presented at: International Stroke Conference; Feb. 9-11, 2022; New Orleans (hybrid meeting).
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