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Secondary Transfer of Stroke Patients for Thrombectomy by Air Ambulance in England: A Cost-Effectiveness Analysis

Lookup NU author(s): Dr Darren Flynn, Dr Diarmuid Coughlan, Dr Paul McMeekin, Professor Gary Ford, Dawn Craig, Stephen Rice, Hannah Lumley, Professor Phil White

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Abstract

Background and Aims: Helicopter Emergency Medical Services(HEMS) for secondary transfer of stroke patients eligible for thrombectomycould have a significant impact on outcomes for patients residing inareas remote from a thrombectomy centre (TC). Remote units cannotsustain a 24/7 thrombectomy service locally and transfer to a TC isnecessary. There are few data on cost-effectiveness of secondary transfervia HEMS to inform commissioning decisions.We are evaluating the costeffectivenessof HEMS versus ground-based ambulance (GBA) for strokethrombectomy in England.Method: Using Geographic Information System data, we identifiedunavoidably remote hospitals serving a population of 800,000 (whereinitiating a local sustainable 24/7 thrombectomy service is not feasible)and >1 hour by GBA from the nearest designated TC. We previouslyestimated the proportion of CT/CTA-confirmed stroke patients admittedwith NIHSS6 within 4.5 hours. Probability of receiving thrombectomyvia HEMS or GBA was derived from average journey times. QualityAdjusted Life Years will be calculated for secondary transfer by HEMSand GBA to the most proximal TC to derive an incremental cost-effectivenessratio.Results: Annual stroke incidence of 3,860 at unavoidably remote hospitals(75km transfer distance), of which 508 patients would be transferredby HEMS. Ongoing survey of HEMS to establish operationalparameters and costs to inform cost effectiveness model is ongoingand will be presented with the health economic data.Conclusion: HEMS is an option for secondary transfer of patients eligiblefor thrombectomy from unavoidably “small” and remote hospitals.Estimates of HEMS cost-effectiveness will be presented to inform theoptimal organisation of thrombectomy service delivery.


Publication metadata

Author(s): Flynn D, Coughlan D, McMeekin P, Ford GA, Craig D, Rice S, Burgess D, Balami J, Mawson A, Lumley H, White P

Publication type: Conference Proceedings (inc. Abstract)

Publication status: Published

Conference Name: European Stroke Organisation Conference

Year of Conference: 2018

Number of Volumes: 3

Pages: 11-11

Print publication date: 01/05/2018

Online publication date: 16/05/2018

Acceptance date: 20/03/2018

Publisher: European Stroke Journal

URL: https://doi.org/10.1177/2396987318770127

DOI: 10.1177/2396987318770127

Sponsor(s): National Institute for Health Research


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