Abstract W P279: Cost-efficiency of Prehospital Stroke Treatment

Background: In acute stroke, time until treatment is crucial for good outcome. Recently, we and others showed that prehospital stroke treatment, based on an ambulance equipped with a CT scanner, point-of-care laboratory and telemedical capabilities, markedly reduces delay until thrombolysis of acute stroke. However, high costs are a major criticism of this novel stroke management strategy. Methods: We simulated costs of prehospital stroke treatment based on data of the first randomized trial (Walter et al., Lancet Neurology 2012) and on secondary data. We assumed a regional specific incidence rate per year and combined current NNT results and estimations of total direct cost per year from secondary sources with results from the controlled trial. Based on these assumptions a range of probable benefit-cost ratios was calculated. Results: Based on different economic assumptions and on statistical projections from the study sample upon the relevant population our estimations indicate that on a one year basis the economic benefit outweighs the cost of the intervention in a range of benefit-cost ratios between 2.7 and 7.3. Due to the relatively high rate of utilization cost-efficiency might be higher in urban than in rural regions, although underserved rural regions might have an especially high medical benefit. As further key factors in cost-efficiency we also identified the size and configuration of the ambulance staff and cost of the ambulance itself. Conclusion: Prehospital stroke treatment is not only efficient in saving crucial time until treatment but also can be cost-efficient. Key factors are, apart from the frequency of utilization, expenses for the staff and for the ambulance. In the future, technical progress of telemedical interaction between ambulance and hospital could allow further reduction of costs.