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Front. Public Health | doi: 10.3389/fpubh.2018.00043

Economic evaluation of a prehospital protocol for patients with suspected acute stroke.

  • 1Community Medicine and Clinical Epidemiology, University of Newcastle, Australia
  • 2Medicine, University of New South Wales, Australia
  • 3Translational Public Health and Evaluation Division, Monash University, Australia
  • 4Translational Public Health and Evaluation Division, Monash University, Australia
  • 5School of Medicine and Public Health, University of Newcastle, Australia

BACKGROUND
In regional and rural Australia, patients experiencing ischaemic stroke do not have equitable access to intravenous recombinant tissue plasminogen activator (tPA). Although thrombolysis with tPA is a clinically proven and cost-effective treatment for eligible stroke patients, there are few economic evaluations on pre-hospital triage interventions to improve access to tPA.

AIM
To describe the potential cost-effectiveness of the Pre-Hospital Acute Stroke Triage (PAST) protocol implemented to provide priority transfer of appropriate patients from smaller hospitals to a Primary Stroke Centre (PSC) in regional New South Wales, Australia.

MATERIALS AND METHODS
The PAST protocol was evaluated using a observational data and historical control design. Using aggregated administrative data, a decision analytic model was used to simulate costs and patient outcomes. During the implementation of the PAST protocol (intervention), patient data were collected prospectively at the PSC. Control patients included two groups i) patients arriving at the PSC in the 12 months before the implementation of the PAST protocol and, ii) patients from the geographical catchment area of the smaller regional hospitals that were previously not bypassed during the control period. Control data were collected retrospectively. The primary outcome of the economic evaluation was the additional cost per disability adjusted life years (DALYs) averted in the intervention period compared to the control period.

RESULTS
The intervention was associated with a 17 times greater odds of eligible patients receiving tPA (adjusted odds ratio, 95% CI 9.42 – 31.2, p<0.05) and the majority of the associated costs were incurred during acute care and rehabilitation. Overall, the intervention was associated with a net avoidance of 93.3 DALYs. The estimated average cost per DALY averted per patient in the intervention group compared to the control group was $10,921.

CONCLUSION
Based on our simulation modelling the triage intervention was a potentially cost-effective strategy for improving access to tPA therapy for patients with ischaemic stroke in regional Australia.

Keywords: Stroke, acute stroke, economic evaluation, prehospital protocol, thrombolysis

Received: 28 Nov 2017; Accepted: 07 Feb 2018.

Edited by:

Nemanja Rancic, Faculty of Medicine, Military Medical Academy, Serbia

Reviewed by:

Guenka I. Petrova, Medical University, Sofia, Bulgaria
Maja Račić, University of East Sarajevo, Bosnia and Herzegovina  

Copyright: © 2018 Lahiry, Levi, Kim, Cadilhac and Searles. 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 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.

* Correspondence: Mr. Suman Lahiry, SL., University of Newcastle, Community Medicine and Clinical Epidemiology, School of Medicine and Public Health (SMPH), Hunter Medical Research Institute (HMRI), LOT 1 kookaburra circuit, New Lambton Heights NSW 2305, Callaghan, 2305, New South Wales, Australia, Suman.Lahiry@uon.edu.au