PMID- 36637359 OWN - NLM STAT- MEDLINE DCOM- 20230517 LR - 20230522 IS - 1531-8249 (Electronic) IS - 0364-5134 (Linking) VI - 93 IP - 5 DP - 2023 May TI - Economic Evaluation of a Mobile Stroke Unit Service in Germany. PG - 942-951 LID - 10.1002/ana.26602 [doi] AB - 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;93:942-951. CI - (c) 2023 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association. FAU - Oliveira Goncalves, Ana Sofia AU - Oliveira Goncalves AS AUID- ORCID: 0000-0002-5678-4137 AD - Institute of Public Health, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Rohmann, Jessica L AU - Rohmann JL AUID- ORCID: 0000-0003-2420-5716 AD - Institute of Public Health, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. AD - Center for Stroke Research Berlin, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Piccininni, Marco AU - Piccininni M AD - Institute of Public Health, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. AD - Center for Stroke Research Berlin, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Kurth, Tobias AU - Kurth T AUID- ORCID: 0000-0001-7169-2620 AD - Institute of Public Health, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Ebinger, Martin AU - Ebinger M AD - Center for Stroke Research Berlin, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. AD - Klinik fur Neurologie, Medical Park Berlin Humboldtmuhle, Berlin, Germany. FAU - Endres, Matthias AU - Endres M AUID- ORCID: 0000-0001-6520-3720 AD - Center for Stroke Research Berlin, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. AD - Klinik und Hochschulambulanz fur Neurologie, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. AD - Berlin Institute of Health (BIH), Berlin, Germany. AD - German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. AD - NeuroCure Cluster of Excellence, Berlin, Germany. AD - German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany. FAU - Freitag, Erik AU - Freitag E AD - Klinik und Hochschulambulanz fur Neurologie, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Harmel, Peter AU - Harmel P AD - Klinik und Hochschulambulanz fur Neurologie, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Lorenz-Meyer, Irina AU - Lorenz-Meyer I AD - Klinik und Hochschulambulanz fur Neurologie, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Rohrpasser-Napierkowski, Ira AU - Rohrpasser-Napierkowski I AD - Klinik und Hochschulambulanz fur Neurologie, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. FAU - Busse, Reinhard AU - Busse R AD - Department of Health Care Management, Berlin University of Technology, Berlin, Germany. AD - European Observatory on Health Systems and Policies, Brussels, Belgium. FAU - Audebert, Heinrich J AU - Audebert HJ AD - Center for Stroke Research Berlin, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. AD - Klinik und Hochschulambulanz fur Neurologie, Charite - Universitatsmedizin Berlin, corporate member of Freie Universitat Berlin und Humboldt Universitat zu Berlin, Berlin, Germany. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230127 PL - United States TA - Ann Neurol JT - Annals of neurology JID - 7707449 SB - IM MH - Humans MH - Cost-Benefit Analysis MH - Quality of Life MH - Prospective Studies MH - *Stroke/therapy MH - *Ischemic Stroke EDAT- 2023/01/14 06:00 MHDA- 2023/05/17 06:42 CRDT- 2023/01/13 09:32 PHST- 2023/01/06 00:00 [revised] PHST- 2022/09/09 00:00 [received] PHST- 2023/01/09 00:00 [accepted] PHST- 2023/05/17 06:42 [medline] PHST- 2023/01/14 06:00 [pubmed] PHST- 2023/01/13 09:32 [entrez] AID - 10.1002/ana.26602 [doi] PST - ppublish SO - Ann Neurol. 2023 May;93(5):942-951. doi: 10.1002/ana.26602. Epub 2023 Jan 27.