Table 3 Study results
Study | Intervention vs. comparator | Incremental costs | Incremental effectiveness | ICERa | Threshold | Conclusion |
|---|---|---|---|---|---|---|
Educational interventions | ||||||
Bayer (2020) [39] | Public information campaign + IVT vs. CP | SD$7,000,000 | 1741 QALYs | SD$4,021/QALY | SD$70,000 | Cost-effective |
Public information campaign + IVT + EVT vs. CP | SD$33,000,000 | 2121 QALYs | SD$15,559/QALY | |||
Public information campaign + other five interventions vs. CP | SD$402,000,000 | 9411 QALYs | SD$ 42,716/QALY | |||
Stevens (2019) [23] | Enhanced educational material vs. SC | $11.85 | 0.00014 QALYs | $84,643/QALY | $100,000 | Cost-effective (II) |
Interactive intervention (II) vs. SC | $10.04 | 0.00017 QALYs | $59,508/QALY | |||
Penaloza-Ramos (2014) [34] | GP staff are trained to better recognize stroke vs. CP | -$32,305 | 2.26 QALYs | - | $30,000 | Dominant |
Reduce time to call emergency service (series of educational interventions) vs. CP | -$16,153 | 1.14 QALYs | - | Dominant | ||
Organizational models | ||||||
Tan (2021) [21] | Telemedicine vs. no telemedicine | -$627 | 0.0925 QALYs | - | $27,736 | Dominant |
Morii (2021) [38] | Mobile interventionist vs. CP in Kamikawachubu | NR | 4.33 QALYs | $12,572/QALY | $48,146 | Cost-effective |
Mobile interventionist vs. CP in HoKumo | NR | 1.58 QALYs | $89,899/QALY | Â | Not cost-effective | |
Mobile interventionist vs. CP in Sapporo | NR | NR | $969,766/QALY | Â | ||
Mobile interventionist vs. CP in Nakasorachi | NR | NR | 1,634,636/QALY | Â | ||
Mobile interventionist vs. CP in Nishiiburi | NR | NR | $567,511/QALY | Â | ||
Mobile interventionist vs. CP in Tokachi | NR | NR | $1,078,899/QALY | Â | ||
Mobile interventionist vs. CP in Kushiro | NR | NR | $1,438,215/QALY | Â | ||
Kim (2021) [40] | Mobile stroke unit vs. standard ambulance and hospital stroke care pathway | AU$1,389,159 | 44.84 DALY avoided | AU$30,982/ DALY avoided | AU$50,000 | Cost-effective |
Yan (2018) [27] | Optimal model (Mothership by ground/air + drip-and-ship by ground/air) vs. mothership by ground | -CA$2,035 | 0.023QALYs | - | CA$50,000 | Dominant |
Whetten (2018) [26] | Access to critical cerebral emergency support services vs. SC | -$4,241 | 0.2 QALYs | - | NR | Dominant |
Espinoza (2017) [36] | SC supplemented with in-ambulance telemedicine vs. SC | -$4,040 | 4.9 QALYs | - | $47,747 | Dominant |
Dietrich (2014) [31] | Mobile stroke unit vs. regular EMS | $208,629 | $408,429 | 1.96b | 1 | Cost-effective |
Torabi (2016) [25] | Telemedicine in outer-ring hospitals + stroke physician location at home vs. CP (none telemedicine + stroke physician location at home) | -$114,500 | 4.9% IVT within 3 h | - | NR | Dominant |
Telemedicine in all hospitals + stroke physician location at home vs. CP | -$242,500 | 5.2% | - | NR | Dominant | |
None telemedicine + stroke physician location at center vs. CP | -$72,500 | 3.7% | - | NR | Dominant | |
Telemedicine in outer-ring hospitals + physician location at center vs. CP | -$180,750 | 8.1% | - | NR | Dominant | |
All telemedicine + physician location at center vs. CP | -$242,500 | 10.5% | - | NR | Dominant | |
Gyrd-Hansen (2015) [32] | Stroke emergency mobile vs. regular EMS | €963,295 | 29.7 QALYs | €32,456/ QALY | NR €36,223c | Cost-effective |
McMeekin (2013) [30] | Redirection to 2 regional neuroscience centers vs. 10 local acute stroke units | £6,730 | 12.6 QALYs | £534/QALY | NR £29,594d | Cost-effective |
Demaerschalk (2013) [22] | Hub-and-spoke telestroke network vs. no network between hub and spokes | -$1,436 | 0.02 QALYs | - | $50,000 | Dominant |
Switzer (2013) [24] | Hub-and-spoke telestroke network vs. no network between hub and spokes | -$358,435 | 6.11 more patients discharged home per year | - | NR | Dominant |
Healthcare delivery infrastructure | ||||||
McMeekin (2019) [29] | 30 EVT centers vs. 24 EVT centers | -£2,870,000 | 213 QALYs | - | £30,000 | Dominant |
Lahr (2017) [33] | Improving stroke care at 9 community hospitals to stroke center vs. CP (9 community hospitals with thrombolysis) | $912 | 8.0% thrombolysis rate | $113/ 1% thrombolysis rate | NR | NR |
Centralization and improve stroke care in 4 hospitals, 5 hospitals without thrombolysis vs. CP | $540 | 7.4% thrombolysis rate | $71/ 1% thrombolysis rate | |||
Centralization and improve stroke care in 2 hospitals and 7 hospitals without thrombolysis vs. CP | $395 | 6.8% thrombolysis rate | $56/ 1% thrombolysis rate | |||
Goff-Pronost (2017) [35] | 8 stroke units (without telemedicine) vs. current situation (3 stroke units and teleconsultation with emergency services in 5 hospitals) | $264 | 0.4% thrombolysis rate | $660/ 1% thrombolysis rate | NR | NR |
Workflow improvement | ||||||
Ajmi (2021) [37] | Quality improvement project, included streamlining stroke care pathway and simulation-based training vs. no quality improvement project | NR | NR | $29/ minute door-to-needle time reduction $10,543/death averted | $43,000/QALY | NR |
Coughlan (2021) [28] | Inter-hospital transfer by helicopter vs. ground EMS | £3,785 | 0.14 QALYs | £28,027/QALY | £ 30,000 | Cost-effective (helicopter) |
Penaloza-Ramos (2014) [34] | Immediate CT scan (e.g. CT scanner moved closer to the emergency department ward) vs. CP | -$24,963 | 1.81 QALYs | - | $30,000 | Dominant |