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Modelling the Efficiency of Local Versus Central Provision of Intravenous Thrombolysis After Acute Ischemic Stroke

Lookup NU author(s): Dr Peter McMeekin, Jo Gray, Professor Gary Ford, Professor Helen Rodgers, Dr Christopher Price

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Abstract

Background and Purpose Prehospital redirection of stroke patients to a regional center is used as a strategy to maximize the provision of intravenous thrombolysis. We developed a model to quantify the benefit of redirection away from local services that were already providing thrombolysis.Methods A microsimulation using hospital and ambulance data from consecutive emergency admissions to 10 local acute stroke units estimated the effect of redirection to 2 regional neuroscience centers. Modeled outcomes reflected additional journey time and accuracy of stroke identification in the prehospital phase, and the relative efficiency of patient selection and door-needle time for each local site compared with the nearest regional neuroscience center.Results Thrombolysis was received by 223/1884 emergency admissions. Based on observed site performance, 68 additional patients would have been treated after theoretical redirection of 1269 true positive cases and 363 stroke mimics to the neuroscience center. Over 5 years redirection of this cohort generated 12.6 quality-adjusted life years at a marginal cost of 6730 ($10 320, Euro8347). The average additional cost of a quality-adjusted life year gain was 534 pound ($819, Euro673).Conclusions Under these specific circumstances, redirection would have improved outcomes from thrombolysis at little additional cost.


Publication metadata

Author(s): McMeekin P, Gray J, Ford GA, Rodgers H, Price CI

Publication type: Article

Publication status: Published

Journal: Stroke

Year: 2013

Volume: 44

Issue: 11

Pages: 3114-3119

Print publication date: 01/11/2013

Online publication date: 27/08/2013

Acceptance date: 26/07/2013

ISSN (print): 0039-2499

ISSN (electronic): 1524-4628

Publisher: Lippincott Williams & Wilkins

URL: http://dx.doi.org/10.1161/STROKEAHA.113.001240

DOI: 10.1161/STROKEAHA.113.001240


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