dc.contributor.author
Schlemm, Ludwig
dc.date.accessioned
2019-04-10T08:26:36Z
dc.date.available
2019-04-10T08:26:36Z
dc.identifier.uri
https://refubium.fu-berlin.de/handle/fub188/24341
dc.identifier.uri
http://dx.doi.org/10.17169/refubium-2113
dc.description.abstract
Background: Ischaemic stroke remains a significant contributor to permanent disability world-wide. Therapeutic interventions for acute ischaemic stroke (AIS) are available, but need to be administered early after symptom onset in order to be effective. Currently, one of the main factors responsible for poor clinical outcome is an unnecessary long time between symptom onset and arrival at a hospital (pre-hospital delay). In the future, technological devices with the capability of real-time detection of AIS may become available. The health economic implications of such devices have not been explored. Methods: We developed a novel probabilistic model to estimate the maximally allowable annual costs of different hypothetical real-time AIS detection devices in different populations given currently accepted willingness-to-pay thresholds. Distributions of model parameters were extracted from the literature. Effectiveness of the intervention was quantified as reduction in disability-adjusted life-years associated with faster access to thrombolysis and mechanical thrombectomy. Incremental costs were calculated from a societal perspective including acute treatment costs and long-term costs for nursing care, home help, and loss of production. The impact of individual model parameters was explored in one-way and multi-way sensitivity analyses. Results: The model yields significantly shorter prehospital delays and a higher proportion of acute ischaemic patients that fulfill the time-based eligibility criteria for thrombolysis or mechanical thrombectomy in the scenario with a real-time stroke detection device as compared to the control scenario. Depending on the sociodemographic and geographic characteristics of the study population and operating characteristics of the device, the maximally allowable annual cost for the device to operate in a cost-effective manner assuming a willingness-to-pay threshold of GBP 30.000 ranges from GBP 22.00 to GBP 9,952.00. Considering the results of multiway sensitivity analyses, the upper bound increases to GBP 29,449.10 in the subgroup of young patients with a very high annual risk of ischaemic stroke (50 years/20% annual risk). Conclusion: Data from probabilistic modeling suggest that real-time AIS detection devices can be expected to be cost-effective only for a small group of highly selected individuals.
en
dc.rights.uri
https://creativecommons.org/licenses/by/4.0/
dc.subject
ischaemic stroke
en
dc.subject
endovascular treatment
en
dc.subject
thrombectomy
en
dc.subject
thrombolysis
en
dc.subject
prehospital triage
en
dc.subject
mathematical modeling
en
dc.subject
cost-effectiveness analysis
en
dc.subject
health economics
en
dc.subject.ddc
600 Technik, Medizin, angewandte Wissenschaften::610 Medizin und Gesundheit::610 Medizin und Gesundheit
dc.title
Disability adjusted life years due to ischaemic stroke preventable by real-time stroke detection - a cost-utility analysis of hypothetical stroke detection devices
dc.type
Wissenschaftlicher Artikel
dcterms.bibliographicCitation.articlenumber
814
dcterms.bibliographicCitation.doi
10.3389/fneur.2018.00814
dcterms.bibliographicCitation.journaltitle
Frontiers in Neurology
dcterms.bibliographicCitation.originalpublishername
Frontiers Media S.A.
dcterms.bibliographicCitation.volume
9
refubium.affiliation
Charité - Universitätsmedizin Berlin
refubium.resourceType.isindependentpub
no
dcterms.accessRights.openaire
open access
dcterms.bibliographicCitation.pmid
30327638
dcterms.isPartOf.issn
1664-2295