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Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport
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 i...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028763/ https://www.ncbi.nlm.nih.gov/pubmed/32116993 http://dx.doi.org/10.3389/fneur.2019.01422 |
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author | Reimer, Andrew P. Zafar, Atif Hustey, Fredric M. Kralovic, Damon Russman, Andrew N. Uchino, Ken Hussain, Muhammad S. Udeh, Belinda L. |
author_facet | Reimer, Andrew P. Zafar, Atif Hustey, Fredric M. Kralovic, Damon Russman, Andrew N. Uchino, Ken Hussain, Muhammad S. Udeh, Belinda L. |
author_sort | Reimer, Andrew P. |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7028763 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-70287632020-02-28 Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport Reimer, Andrew P. Zafar, Atif Hustey, Fredric M. Kralovic, Damon Russman, Andrew N. Uchino, Ken Hussain, Muhammad S. Udeh, Belinda L. Front Neurol Neurology 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. Frontiers Media S.A. 2020-02-12 /pmc/articles/PMC7028763/ /pubmed/32116993 http://dx.doi.org/10.3389/fneur.2019.01422 Text en Copyright © 2020 Reimer, Zafar, Hustey, Kralovic, Russman, Uchino, Hussain and Udeh. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Neurology Reimer, Andrew P. Zafar, Atif Hustey, Fredric M. Kralovic, Damon Russman, Andrew N. Uchino, Ken Hussain, Muhammad S. Udeh, Belinda L. Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport |
title | Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport |
title_full | Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport |
title_fullStr | Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport |
title_full_unstemmed | Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport |
title_short | Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport |
title_sort | cost-consequence analysis of mobile stroke units vs. standard prehospital care and transport |
topic | Neurology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028763/ https://www.ncbi.nlm.nih.gov/pubmed/32116993 http://dx.doi.org/10.3389/fneur.2019.01422 |
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