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Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review

BACKGROUND: Reducing delays along the acute stroke pathway significantly improves clinical outcomes for acute ischemic stroke patients eligible for reperfusion treatments. The economic impact of different strategies reducing onset to treatment (OTT) is crucial information for stakeholders in acute s...

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Autores principales: Nguyen, Chi Phuong, Maas, Willemijn J., van der Zee, Durk-Jouke, Uyttenboogaart, Maarten, Buskens, Erik, Lahr, Maarten M. H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064746/
https://www.ncbi.nlm.nih.gov/pubmed/36998011
http://dx.doi.org/10.1186/s12913-023-09310-0
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author Nguyen, Chi Phuong
Maas, Willemijn J.
van der Zee, Durk-Jouke
Uyttenboogaart, Maarten
Buskens, Erik
Lahr, Maarten M. H.
author_facet Nguyen, Chi Phuong
Maas, Willemijn J.
van der Zee, Durk-Jouke
Uyttenboogaart, Maarten
Buskens, Erik
Lahr, Maarten M. H.
author_sort Nguyen, Chi Phuong
collection PubMed
description BACKGROUND: Reducing delays along the acute stroke pathway significantly improves clinical outcomes for acute ischemic stroke patients eligible for reperfusion treatments. The economic impact of different strategies reducing onset to treatment (OTT) is crucial information for stakeholders in acute stroke management. This systematic review aimed to provide an overview on the cost-effectiveness of several strategies to reduce OTT. METHODS: A comprehensive literature search was conducted in EMBASE, PubMed, and Web of Science until January 2022. Studies were included if they reported 1/ stroke patients treated with intravenous thrombolysis and/or endovascular thrombectomy, 2/ full economic evaluation, and 3/ strategies to reduce OTT. The Consolidated Health Economic Evaluation Reporting Standards statement was applied to assess the reporting quality. RESULTS: Twenty studies met the inclusion criteria, of which thirteen were based on cost-utility analysis with the incremental cost-effectiveness ratio per quality-adjusted life year gained as the primary outcome. Studies were performed in twelve countries focusing on four main strategies: educational interventions, organizational models, healthcare delivery infrastructure, and workflow improvements. Sixteen studies showed that the strategies concerning educational interventions, telemedicine between hospitals, mobile stroke units, and workflow improvements, were cost-effective in different settings. The healthcare perspective was predominantly used, and the most common types of models were decision trees, Markov models and simulation models. Overall, fourteen studies were rated as having high reporting quality (79%-94%). CONCLUSIONS: A wide range of strategies aimed at reducing OTT is cost-effective in acute stroke care treatment. Existing pathways and local characteristics need to be taken along in assessing proposed improvements. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09310-0.
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spelling pubmed-100647462023-04-01 Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review Nguyen, Chi Phuong Maas, Willemijn J. van der Zee, Durk-Jouke Uyttenboogaart, Maarten Buskens, Erik Lahr, Maarten M. H. BMC Health Serv Res Research BACKGROUND: Reducing delays along the acute stroke pathway significantly improves clinical outcomes for acute ischemic stroke patients eligible for reperfusion treatments. The economic impact of different strategies reducing onset to treatment (OTT) is crucial information for stakeholders in acute stroke management. This systematic review aimed to provide an overview on the cost-effectiveness of several strategies to reduce OTT. METHODS: A comprehensive literature search was conducted in EMBASE, PubMed, and Web of Science until January 2022. Studies were included if they reported 1/ stroke patients treated with intravenous thrombolysis and/or endovascular thrombectomy, 2/ full economic evaluation, and 3/ strategies to reduce OTT. The Consolidated Health Economic Evaluation Reporting Standards statement was applied to assess the reporting quality. RESULTS: Twenty studies met the inclusion criteria, of which thirteen were based on cost-utility analysis with the incremental cost-effectiveness ratio per quality-adjusted life year gained as the primary outcome. Studies were performed in twelve countries focusing on four main strategies: educational interventions, organizational models, healthcare delivery infrastructure, and workflow improvements. Sixteen studies showed that the strategies concerning educational interventions, telemedicine between hospitals, mobile stroke units, and workflow improvements, were cost-effective in different settings. The healthcare perspective was predominantly used, and the most common types of models were decision trees, Markov models and simulation models. Overall, fourteen studies were rated as having high reporting quality (79%-94%). CONCLUSIONS: A wide range of strategies aimed at reducing OTT is cost-effective in acute stroke care treatment. Existing pathways and local characteristics need to be taken along in assessing proposed improvements. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-023-09310-0. BioMed Central 2023-03-30 /pmc/articles/PMC10064746/ /pubmed/36998011 http://dx.doi.org/10.1186/s12913-023-09310-0 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Nguyen, Chi Phuong
Maas, Willemijn J.
van der Zee, Durk-Jouke
Uyttenboogaart, Maarten
Buskens, Erik
Lahr, Maarten M. H.
Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
title Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
title_full Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
title_fullStr Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
title_full_unstemmed Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
title_short Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
title_sort cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10064746/
https://www.ncbi.nlm.nih.gov/pubmed/36998011
http://dx.doi.org/10.1186/s12913-023-09310-0
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