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Table 3 Simulation Results

From: Estimating the effectiveness and cost-effectiveness of establishing additional endovascular Thrombectomy stroke Centres in England: a discrete event simulation

Outcome

Estimate

Mean time to treatment reduction (SD)

42 min (SD 63)

Changes in population mRS (n) *

 0

15

 1

18

 2

-4

 3

-10

 4

−8

 5

−8

 6

−4

Marginal Lifetime QALY gains across English pop.

213 (95% CI 28, 447)

Marginal Lifetime costs to NHS England

-£2,870,000 (95% CI -£7,946,000 to £2,051,000)

Net Benefit at £20,000 per QALYb

£7,123,000 (95% CI £1,039,000 to £13,666,000)

Net Benefit at £25,000 per QALYb

£8,187,000 (95% CI £1,609,000 to £ 15,684,000)

Net Benefit at £30,000 per QALYb

£ 9,250,000 (95% CI £1,983,000 to £ 17,532,000)

Budget Impact Analysis

 Year 1

-£981,000(95% CI -£2,067,000 to £218,000)

 Years 2 to 5 (discounted)

- £1,186,000 (95% CI -£3,587,000 to £1,187,000)

Sensitivity Analyses expressed as change in Net Benefit at £25,000 willingness to pay for QALY

 Use of Ambulance Tariff

£20,000

 1% increase in LAO incidence

£93,000

 1% decrease in LAO incidence

-£72,000

 Mean age at stroke −5 years (65)

£1,023,000 22 additional QALYs, additional savings of £473,000

 Mean age at stroke + 5 years (75)

-£934,000 27 fewer QALYs, reduction in savings of £259,000

  1. aRounded to nearest number of patients
  2. bNet benefit is calculated by deducting the ‘value’ of QALYs generated from increased costs