Table 1 Study characteristics
Study | Country of origin | Strategy/ Intervention | Comparator | Type of economic evaluation | Outcome of effectiveness | Type of model | Economic perspective | Time horizon (Discount rate) | Reference year of cost |
|---|---|---|---|---|---|---|---|---|---|
Ajmi (2021) [37] | Norway | Quality improvement project, including streamlining stroke care pathwaya and simulation-based training | No quality improvement project | Cost-effectiveness | Door-to-needle times, 90-day all-cause mortality | Economic evaluation along with clinical trial | Health care | 5Â years (NR) | 2019 |
Tan (2021) [21] | China | Telemedicine between hub and spoke centers | No telemedicine | Cost-utility | QALY | Decision tree and Markov model | Societal and healthcare | 30Â years (3%) | 2019 |
Coughlan (2021) [28] | England | Inter-hospital transfer by helicopter EMS | Ground EMS | Cost-utility | QALY | Decision tree and Markov model | National health service | Lifetime (3.5%) | 2018 |
Kim (2021) [40] | Australia | Mobile stroke unitb | Standard ambulance and hospital stroke care pathway | Cost-utility | DALY | Economic simulation model | Healthcare providers | 5Â years (5%) | 2018 |
Morii (2021) [38] | Japan | Mobile interventionistc | Patients treated with EVT in hub facilities | Cost-utility | QALY | Simulation model | Government | 3Â years (2%) | 2020 |
Bayer (2020) [39] | Singapore | A public information campaign to raise awareness of stroke symptoms and urgency (combined with other interventions) | Current practice | Cost-utility | QALY | Population-level systems dynamics model | Healthcare payer | 15Â years (3%) | NR |
McMeekin (2019) [29] | England | 30 EVT centers | 24 EVT centers | Cost-utility | QALY | Discrete event simulation | Payer | 5Â years (NR) | 2017 |
Stevens (2019) [23] | US | Intervention 1: enhanced educational material Intervention 2: interactive interventiond | Standard care | Cost-utility | Life year gain, QALY | Markov model | Societal and healthcare | 5Â years (3%) | 2015 |
Whetten (2018) [26] | US | Access to critical cerebral emergency support services | Standard care | Cost-utility | QALY | Decision tree model | Healthcare payer | 90Â days (NR) | 2015 |
Yan (2018) [27] | Canada | Combine different modes of transportation: -Mothershipe| by ground/ air -Drip-and-shipf by ground/ air to minimum time to IVT -drip-and-ship by ground/air to minimum time to EVT | Mothership by ground | Cost-utility | QALY | Decision tree and Markov model | Payer | Lifetime (5%) | NR |
Lahr (2017) [33] | Netherlands | Intervention 1: 10 stroke centers Intervention 2: 5 stroke centers + 5 hospitals without IVT Intervention 3: 3 stroke centers + 7 hospitals without IVT | Current situation: 9 community hospitals with IVT + 1 stroke center | Cost-effectiveness | Thrombolysis rate, OTT time, extra healthy life days | Discrete event simulation | Policymaker | NR (NR) | NR |
Goff-Pronost (2017) [35] | France | 8 SUs without teleconsultation | 3 SUs and teleconsultation with emergency services in 5 hospitals | Cost-effectiveness | Thrombolysis rate | Decision tree-based analytical model | Hospital | 1Â year (NR) | NR |
Espinoza (2017) [36] | Belgium | Standard stroke care supplemented with in-ambulance telemedicine | Standard stroke care | Cost-utility | QALY | Decision tree and Markov model | Healthcare payer | Lifetime (3% for costs and 1.5% for QALY) | 2014 |
Torabi (2016) [25] | US | Intervention 1: telemedicine in outer-ring hospitals + stroke physician location at home Intervention 2: telemedicine in all hospitals + stroke physician location at home Intervention 3: no telemedicine + stroke physician location at center Intervention 4: telemedicine in outer-ring hospitals + physician location at center Intervention 5: telemedicine in all hospitals + physician location at center | No telemedicine + stroke physician location at home | Cost-effectiveness | OTT time, door-to-needle time, % of IVT within 3 h | Monte Carlo simulation model | NR | Lifetime (3%) | NR |
Gyrd-Hansen (2015) [32] | Germany | Stroke emergency mobile | Normal EMS | Cost-utility | QALY | Economic evaluation along with clinical trial | Third-party payer | 5Â years (3%) | NR |
Penaloza-Ramos (2014) [34] | England | Intervention 1: Divert GP calls ambulance service Intervention 2: Reduce time to call emergency service (series of educational interventions) Intervention 3: Immediate CT scan (CT scanner moved closer to the emergency department ward) | Current practice | Cost-utility | QALY | Decision tree model | National health service and Personal Social Services | Lifetime (3.5%) | 2011 |
Dietrich (2014) [31] | Germany | Mobile stroke unit†| Normal EMS | Cost–benefit | Monetary benefit | 1-year model | NR | 1 year (NR) | NR |
McMeekin (2013) [30] | England | Central provision of 2 regional IVT centers | 10 local acute SUs | Cost-utility | QALY | Microsimulation (with Markov component) | NR | 5Â years (NR) | 2011 |
Demaerschalk (2013) [22] | US | Hub-and-spoke telestroke network | No network between hub and spokes | Cost-utility | QALY | Markov model | Societal | Lifetime (3%) | 2011 |
Switzer (2013) [24] | US | Hub-and-spoke telestroke network | No network between hub and spokes | Cost-effectiveness | Number of home discharges, inpatient rehabilitation/ nursing home discharges, in-hospital deaths | Decision analytic model | A network, a hub hospital, and a spoke hospital | 5Â years (3%) | 2011 |