Economic Evaluation of a Mobile Stroke Unit Service in Germany

Background: Lower global disability and higher quality of life among ischemic stroke patients was found to be associated with the dispatch of mobile stroke units (MSUs) among patients eligible for recanalizing treatments in the Berlin_Prehospital Or Usual Delivery of stroke care (B_PROUD) study. The current study assessed the cost-utility and cost-effectiveness of additional MSU dispatch using data from this prospective, controlled, intervention study.Methods: Outcomes considered in the economic evaluation included quality-adjusted life years (QALYs) derived from the 3-level version of EQ-5D (EQ-5D-3L) and modified Rankin Scale (mRS) scores for functional outcomes 3-months after stroke. Costs were prospectively collected during the study by the MSU provider (Berlin Fire Brigade) and the B_PROUD research team. We focus our results on the societal perspective. As we aimed to determine the economic consequences of the intervention beyond the study's follow-up period, both care costs and QALYs were extrapolated over 5 years.Results: The additional MSU dispatch resulted in an incremental euro40,984 per QALY. The best-case scenario and the worst-case scenario yielded additional costs of, respectively, euro24,470.76 and euro61,690.88 per QALY. In the cost-effectiveness analysis, MSU dispatch resulted in incremental costs of euro81,491 per survival without disability. The best-case scenario and the worst-case scenario yielded additional costs of, respectively, euro44,455.30 and euro116,491.15 per survival without disability.Interpretation: Among patients eligible for recanalizing treatments in ischemic stroke, MSU dispatch was associated with both higher QALYs and higher costs and is cost-effective when considering internationally accepted thresholds ranging from an additional euro40,000 to euro80,000 per QALY. ANN NEUROL 2023

Automated summary

The study assessed the cost-utility and cost-effectiveness of additional mobile stroke unit (MSU) dispatch in ischemic stroke patients eligible for recanalizing treatments. Results showed that MSU dispatch increased costs but also improved quality-adjusted life years (QALYs), and it was considered cost-effective according to internationally accepted thresholds.