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Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke

BACKGROUND AND PURPOSE: Pre-hospital severity-based triaging using the Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST) algorithm has been demonstrated to substantially reduce time to endovascular thrombectomy in Melbourne, Australia. We aimed to model the cost-effectiveness of an ACT...

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Autores principales: Gao, Lan, Moodie, Marj, Yassi, Nawaf, Davis, Stephen M., Bladin, Christopher F., Smith, Karen, Bernard, Stephen, Stephenson, Michael, Churilov, Leonid, Campbell, Bruce C. V., Zhao, Henry
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9136079/
https://www.ncbi.nlm.nih.gov/pubmed/35645977
http://dx.doi.org/10.3389/fneur.2022.871999
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author Gao, Lan
Moodie, Marj
Yassi, Nawaf
Davis, Stephen M.
Bladin, Christopher F.
Smith, Karen
Bernard, Stephen
Stephenson, Michael
Churilov, Leonid
Campbell, Bruce C. V.
Zhao, Henry
author_facet Gao, Lan
Moodie, Marj
Yassi, Nawaf
Davis, Stephen M.
Bladin, Christopher F.
Smith, Karen
Bernard, Stephen
Stephenson, Michael
Churilov, Leonid
Campbell, Bruce C. V.
Zhao, Henry
author_sort Gao, Lan
collection PubMed
description BACKGROUND AND PURPOSE: Pre-hospital severity-based triaging using the Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST) algorithm has been demonstrated to substantially reduce time to endovascular thrombectomy in Melbourne, Australia. We aimed to model the cost-effectiveness of an ACT-FAST bypass system from the healthcare system perspective. METHODS: A simulation model was developed to estimate the long-term costs and health benefits associated with diagnostic accuracy of the ACT-FAST algorithm. Three-month post stroke functional outcome was projected to the lifetime horizon to estimate the long-term cost-effectiveness between two strategies (ACT-FAST vs. standard care pathways). For ACT-FAST screened true positives (i.e., screened positive and eligible for EVT), a 52 mins time saving was applied unanimously to the onset to arterial time for EVT, while 10 mins delay in thrombolysis was applied for false-positive (i.e., screened positive but was ineligible for EVT) thrombolysis-eligible infarction. Quality-adjusted life year (QALY) was employed as the outcome measure to calculate the incremental cost-effectiveness ratio (ICER) between the ACT-FAST algorithm and the current standard care pathway. RESULTS: Over the lifetime, ACT-FAST was associated with lower costs (–$45) and greater QALY gains (0.006) compared to the current standard care pathway, resulting in it being the dominant strategy (less costly but more health benefits). Implementing ACT-FAST triaging led to higher proportion of patients received EVT procedure (30 more additional EVT performed per 10,000 patients). The total Net Monetary Benefit from ACT-FAST care estimated at A$0.76 million based on its implementation for a single year. CONCLUSIONS: An ACT-FAST severity-triaging strategy is associated with cost-saving and increased benefits when compared to standard care pathways. Implementing ACT-FAST triaging increased the proportion of patients who received EVT procedure due to more patients arriving at EVT-capable hospitals within the 6-h time window (when imaging selection is less rigorous).
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spelling pubmed-91360792022-05-28 Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke Gao, Lan Moodie, Marj Yassi, Nawaf Davis, Stephen M. Bladin, Christopher F. Smith, Karen Bernard, Stephen Stephenson, Michael Churilov, Leonid Campbell, Bruce C. V. Zhao, Henry Front Neurol Neurology BACKGROUND AND PURPOSE: Pre-hospital severity-based triaging using the Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST) algorithm has been demonstrated to substantially reduce time to endovascular thrombectomy in Melbourne, Australia. We aimed to model the cost-effectiveness of an ACT-FAST bypass system from the healthcare system perspective. METHODS: A simulation model was developed to estimate the long-term costs and health benefits associated with diagnostic accuracy of the ACT-FAST algorithm. Three-month post stroke functional outcome was projected to the lifetime horizon to estimate the long-term cost-effectiveness between two strategies (ACT-FAST vs. standard care pathways). For ACT-FAST screened true positives (i.e., screened positive and eligible for EVT), a 52 mins time saving was applied unanimously to the onset to arterial time for EVT, while 10 mins delay in thrombolysis was applied for false-positive (i.e., screened positive but was ineligible for EVT) thrombolysis-eligible infarction. Quality-adjusted life year (QALY) was employed as the outcome measure to calculate the incremental cost-effectiveness ratio (ICER) between the ACT-FAST algorithm and the current standard care pathway. RESULTS: Over the lifetime, ACT-FAST was associated with lower costs (–$45) and greater QALY gains (0.006) compared to the current standard care pathway, resulting in it being the dominant strategy (less costly but more health benefits). Implementing ACT-FAST triaging led to higher proportion of patients received EVT procedure (30 more additional EVT performed per 10,000 patients). The total Net Monetary Benefit from ACT-FAST care estimated at A$0.76 million based on its implementation for a single year. CONCLUSIONS: An ACT-FAST severity-triaging strategy is associated with cost-saving and increased benefits when compared to standard care pathways. Implementing ACT-FAST triaging increased the proportion of patients who received EVT procedure due to more patients arriving at EVT-capable hospitals within the 6-h time window (when imaging selection is less rigorous). Frontiers Media S.A. 2022-05-13 /pmc/articles/PMC9136079/ /pubmed/35645977 http://dx.doi.org/10.3389/fneur.2022.871999 Text en Copyright © 2022 Gao, Moodie, Yassi, Davis, Bladin, Smith, Bernard, Stephenson, Churilov, Campbell and Zhao. https://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
Gao, Lan
Moodie, Marj
Yassi, Nawaf
Davis, Stephen M.
Bladin, Christopher F.
Smith, Karen
Bernard, Stephen
Stephenson, Michael
Churilov, Leonid
Campbell, Bruce C. V.
Zhao, Henry
Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
title Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
title_full Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
title_fullStr Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
title_full_unstemmed Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
title_short Long-Term Cost-Effectiveness of Severity-Based Triaging for Large Vessel Occlusion Stroke
title_sort long-term cost-effectiveness of severity-based triaging for large vessel occlusion stroke
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9136079/
https://www.ncbi.nlm.nih.gov/pubmed/35645977
http://dx.doi.org/10.3389/fneur.2022.871999
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