Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke
BackgroundDespite the proven cost effectiveness of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion, treatment within 6 hours from symptom onset remains inaccessible for many patients. We aimed to find the optimal number and location of treatmen...
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| Veröffentlicht in: | Journal of neurointerventional surgery 2024-02, Vol.16 (2), p.156-162 |
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| creator | Ennab Vogel, Nicklas Wester, Per Andersson Granberg, Tobias Levin, Lars-Åke |
| description | BackgroundDespite the proven cost effectiveness of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion, treatment within 6 hours from symptom onset remains inaccessible for many patients. We aimed to find the optimal number and location of treatment facilities with respect to the cost effectiveness of MT in patients with AIS, first by the most cost effective implementation of comprehensive stroke centers (CSCs), and second by the most cost effective addition of complementary thrombectomy capable stroke centers (TSCs).MethodsThis study was based on nationwide observational data comprising 18 793 patients with suspected AIS potentially eligible for treatment with MT. The most cost effective solutions were attained by solving the p median facility location–allocation problem with the objective function of maximizing the incremental net monetary benefit (INMB) of MT compared with no MT in patients with AIS. Deterministic sensitivity analysis (DSA) was used as the basis of the results analysis.ResultsThe implementation strategy with seven CSCs produced the highest annual INMB per patient of all possible solutions in the base case scenario. The most cost effective implementation strategy of the extended scenario comprised seven CSCs and four TSCs. DSA revealed sensitivity to variability in MT rate and the maximum willingness to pay per quality adjusted life year gained.ConclusionThe combination of optimization modeling and cost effectiveness analysis provides a powerful tool for configuring the extent and locations of CSCs (and TSCs). The most cost effective implementation of CSCs in Sweden entails 24/7 MT services at all seven university hospitals. |
| doi_str_mv | 10.1136/jnis-2023-020299 |
| format | Article |
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We aimed to find the optimal number and location of treatment facilities with respect to the cost effectiveness of MT in patients with AIS, first by the most cost effective implementation of comprehensive stroke centers (CSCs), and second by the most cost effective addition of complementary thrombectomy capable stroke centers (TSCs).MethodsThis study was based on nationwide observational data comprising 18 793 patients with suspected AIS potentially eligible for treatment with MT. The most cost effective solutions were attained by solving the p median facility location–allocation problem with the objective function of maximizing the incremental net monetary benefit (INMB) of MT compared with no MT in patients with AIS. Deterministic sensitivity analysis (DSA) was used as the basis of the results analysis.ResultsThe implementation strategy with seven CSCs produced the highest annual INMB per patient of all possible solutions in the base case scenario. The most cost effective implementation strategy of the extended scenario comprised seven CSCs and four TSCs. DSA revealed sensitivity to variability in MT rate and the maximum willingness to pay per quality adjusted life year gained.ConclusionThe combination of optimization modeling and cost effectiveness analysis provides a powerful tool for configuring the extent and locations of CSCs (and TSCs). The most cost effective implementation of CSCs in Sweden entails 24/7 MT services at all seven university hospitals.</description><identifier>ISSN: 1759-8478</identifier><identifier>ISSN: 1759-8486</identifier><identifier>EISSN: 1759-8486</identifier><identifier>DOI: 10.1136/jnis-2023-020299</identifier><identifier>PMID: 37072170</identifier><language>eng</language><publisher>BMA House, Tavistock Square, London, WC1H 9JR: BMJ Publishing Group Ltd</publisher><subject>Brain Ischemia - surgery ; Cost-Benefit Analysis ; Cost-Effectiveness Analysis ; Costs ; Economic models ; economics ; Emergency medical care ; Emergency services ; Generalized linear models ; Hospitals ; Humans ; intervention ; Ischemia ; Ischemic Stroke ; Ischemic Stroke - surgery ; Patients ; Roads & highways ; Stroke ; Stroke - surgery ; thrombectomy ; Thrombectomy - methods ; thrombolysis ; Transportation planning ; Treatment Outcome ; Workforce planning</subject><ispartof>Journal of neurointerventional surgery, 2024-02, Vol.16 (2), p.156-162</ispartof><rights>Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2023 Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2024 Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b604t-72f03edb827bd4708189500ba963a5484214f03fbcc6d728354832d78c8a09543</citedby><cites>FETCH-LOGICAL-b604t-72f03edb827bd4708189500ba963a5484214f03fbcc6d728354832d78c8a09543</cites><orcidid>0000-0002-1715-8862</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,550,776,881</link.rule.ids><linktorsrc>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-194182$$EView_record_in_Swedish_Publication_Index_(SWEPUB)$$FView_record_in_$$GSwedish_Publication_Index_(SWEPUB)$$Hfree_for_read</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37072170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-194182$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-209175$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:152606109$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Ennab Vogel, Nicklas</creatorcontrib><creatorcontrib>Wester, Per</creatorcontrib><creatorcontrib>Andersson Granberg, Tobias</creatorcontrib><creatorcontrib>Levin, Lars-Åke</creatorcontrib><title>Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke</title><title>Journal of neurointerventional surgery</title><addtitle>J NeuroIntervent Surg</addtitle><addtitle>J Neurointerv Surg</addtitle><description>BackgroundDespite the proven cost effectiveness of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion, treatment within 6 hours from symptom onset remains inaccessible for many patients. We aimed to find the optimal number and location of treatment facilities with respect to the cost effectiveness of MT in patients with AIS, first by the most cost effective implementation of comprehensive stroke centers (CSCs), and second by the most cost effective addition of complementary thrombectomy capable stroke centers (TSCs).MethodsThis study was based on nationwide observational data comprising 18 793 patients with suspected AIS potentially eligible for treatment with MT. The most cost effective solutions were attained by solving the p median facility location–allocation problem with the objective function of maximizing the incremental net monetary benefit (INMB) of MT compared with no MT in patients with AIS. Deterministic sensitivity analysis (DSA) was used as the basis of the results analysis.ResultsThe implementation strategy with seven CSCs produced the highest annual INMB per patient of all possible solutions in the base case scenario. The most cost effective implementation strategy of the extended scenario comprised seven CSCs and four TSCs. DSA revealed sensitivity to variability in MT rate and the maximum willingness to pay per quality adjusted life year gained.ConclusionThe combination of optimization modeling and cost effectiveness analysis provides a powerful tool for configuring the extent and locations of CSCs (and TSCs). The most cost effective implementation of CSCs in Sweden entails 24/7 MT services at all seven university hospitals.</description><subject>Brain Ischemia - surgery</subject><subject>Cost-Benefit Analysis</subject><subject>Cost-Effectiveness Analysis</subject><subject>Costs</subject><subject>Economic models</subject><subject>economics</subject><subject>Emergency medical care</subject><subject>Emergency services</subject><subject>Generalized linear models</subject><subject>Hospitals</subject><subject>Humans</subject><subject>intervention</subject><subject>Ischemia</subject><subject>Ischemic Stroke</subject><subject>Ischemic Stroke - surgery</subject><subject>Patients</subject><subject>Roads & highways</subject><subject>Stroke</subject><subject>Stroke - surgery</subject><subject>thrombectomy</subject><subject>Thrombectomy - methods</subject><subject>thrombolysis</subject><subject>Transportation planning</subject><subject>Treatment Outcome</subject><subject>Workforce planning</subject><issn>1759-8478</issn><issn>1759-8486</issn><issn>1759-8486</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>ACMMV</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>D8T</sourceid><recordid>eNqNks1u1DAUhSMEoqWwZ4UssemCwLWdxM4KVeVXqtQNsLUcx-l4GtuD7Uw1vAYvjEOGgSJRsUks-zvnOienKJ5ieIkxbV6tnYklAUJLyM-2vVccY1a3Ja94c_-wZvyoeBTjGqBhNasfFkeUASOYwXHx_XKTjDXfdI967aJJOyRdj0avZDLeReQHFFPw1xop7ZIOEQ0-IGM3wW-zSPmYkB4GrZLZaqfjT4XVaiWdUXJEaRW87fKxtztkHNpk32wU0Y1JKyTVlDQyUa20NWo_6XHxYJBj1E_275Pi87u3n84_lBeX7z-en12UXQNVKhkZgOq-44R1fcWAY97WAJ1sGyrrilcEV5kYOqWanhFO8x4lPeOKS2jrip4U5eIbb_Rm6sQmGCvDTnhpxH7rOq-0aBhrAN_JvzFfzoQPV2KykyDQ5uj_jx_NJHBbYU4y_3rhM2x1P-cd5HhLdvvEmZW48luBgdf537bZ4XTvEPzXScckbM5Wj6N02k9REA6UUgAyD3v-F7r2U3A5b0FanAuCs-OdFAdSY1K3c5CwUCr4GIMeDnfGIOaiirmoYi6qWIqaJc_-_NaD4FczM_BiATq7_j30n34_ABu_9b4</recordid><startdate>20240201</startdate><enddate>20240201</enddate><creator>Ennab Vogel, Nicklas</creator><creator>Wester, Per</creator><creator>Andersson Granberg, Tobias</creator><creator>Levin, Lars-Åke</creator><general>BMJ Publishing Group Ltd</general><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><scope>ABXSW</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>DG8</scope><scope>ZZAVC</scope><scope>ADHXS</scope><scope>D93</scope><orcidid>https://orcid.org/0000-0002-1715-8862</orcidid></search><sort><creationdate>20240201</creationdate><title>Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke</title><author>Ennab Vogel, Nicklas ; Wester, Per ; Andersson Granberg, Tobias ; Levin, Lars-Åke</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b604t-72f03edb827bd4708189500ba963a5484214f03fbcc6d728354832d78c8a09543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Brain Ischemia - surgery</topic><topic>Cost-Benefit Analysis</topic><topic>Cost-Effectiveness Analysis</topic><topic>Costs</topic><topic>Economic models</topic><topic>economics</topic><topic>Emergency medical care</topic><topic>Emergency services</topic><topic>Generalized linear models</topic><topic>Hospitals</topic><topic>Humans</topic><topic>intervention</topic><topic>Ischemia</topic><topic>Ischemic Stroke</topic><topic>Ischemic Stroke - surgery</topic><topic>Patients</topic><topic>Roads & highways</topic><topic>Stroke</topic><topic>Stroke - surgery</topic><topic>thrombectomy</topic><topic>Thrombectomy - methods</topic><topic>thrombolysis</topic><topic>Transportation planning</topic><topic>Treatment Outcome</topic><topic>Workforce planning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ennab Vogel, Nicklas</creatorcontrib><creatorcontrib>Wester, Per</creatorcontrib><creatorcontrib>Andersson Granberg, Tobias</creatorcontrib><creatorcontrib>Levin, Lars-Åke</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Linköpings universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Linköpings universitet</collection><collection>SwePub Articles full text</collection><collection>SWEPUB Umeå universitet full text</collection><collection>SWEPUB Umeå universitet</collection><jtitle>Journal of neurointerventional surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Ennab Vogel, Nicklas</au><au>Wester, Per</au><au>Andersson Granberg, Tobias</au><au>Levin, Lars-Åke</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke</atitle><jtitle>Journal of neurointerventional surgery</jtitle><stitle>J NeuroIntervent Surg</stitle><addtitle>J Neurointerv Surg</addtitle><date>2024-02-01</date><risdate>2024</risdate><volume>16</volume><issue>2</issue><spage>156</spage><epage>162</epage><pages>156-162</pages><issn>1759-8478</issn><issn>1759-8486</issn><eissn>1759-8486</eissn><abstract>BackgroundDespite the proven cost effectiveness of mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion, treatment within 6 hours from symptom onset remains inaccessible for many patients. We aimed to find the optimal number and location of treatment facilities with respect to the cost effectiveness of MT in patients with AIS, first by the most cost effective implementation of comprehensive stroke centers (CSCs), and second by the most cost effective addition of complementary thrombectomy capable stroke centers (TSCs).MethodsThis study was based on nationwide observational data comprising 18 793 patients with suspected AIS potentially eligible for treatment with MT. The most cost effective solutions were attained by solving the p median facility location–allocation problem with the objective function of maximizing the incremental net monetary benefit (INMB) of MT compared with no MT in patients with AIS. Deterministic sensitivity analysis (DSA) was used as the basis of the results analysis.ResultsThe implementation strategy with seven CSCs produced the highest annual INMB per patient of all possible solutions in the base case scenario. The most cost effective implementation strategy of the extended scenario comprised seven CSCs and four TSCs. DSA revealed sensitivity to variability in MT rate and the maximum willingness to pay per quality adjusted life year gained.ConclusionThe combination of optimization modeling and cost effectiveness analysis provides a powerful tool for configuring the extent and locations of CSCs (and TSCs). The most cost effective implementation of CSCs in Sweden entails 24/7 MT services at all seven university hospitals.</abstract><cop>BMA House, Tavistock Square, London, WC1H 9JR</cop><pub>BMJ Publishing Group Ltd</pub><pmid>37072170</pmid><doi>10.1136/jnis-2023-020299</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-1715-8862</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Brain Ischemia - surgery Cost-Benefit Analysis Cost-Effectiveness Analysis Costs Economic models economics Emergency medical care Emergency services Generalized linear models Hospitals Humans intervention Ischemia Ischemic Stroke Ischemic Stroke - surgery Patients Roads & highways Stroke Stroke - surgery thrombectomy Thrombectomy - methods thrombolysis Transportation planning Treatment Outcome Workforce planning |
| title | Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke |
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