Cost-Effectiveness Analyses of Acute Ischemic Stroke Care Pathways: A Model for Different Scenarios and Countries

OBJECTIVES: Acute ischemic stroke (AIS) is a leading cause of disability and mortality worldwide, resulting in a significant economic burden on healthcare. The Stroke Action Plan for Europe has set targets along the care pathway to improve outcomes. This study aims to perform a scenario analysis on the cost-effectiveness of the AIS care pathway across different countries, to estimate the impact of country-specific improvements on acute and long-term costs and patient outcomes in AIS.

METHODS: We modeled the current AIS care pathway using a combination of a decision tree and a Markov model. The model allowed for the adaptation of parameters to reflect the specificities of multiple countries, and the inclusion of diverse scenarios, facilitating broad applicability. The model was applied to data from different countries to estimate the incremental cost-effectiveness ratio (ICER) of these scenarios. Data sources included real-world data from national healthcare databases and published literature. Sensitivity analyses explored parameter uncertainty and model robustness.

RESULTS: Our analysis showed variability in the ICERs across the countries and scenarios examined. For instance, in Germany, doubling the EVT treatment rate resulted in a QALY gain of 0.07 and lifetime cost savings of €679.59 per patient, totaling €180M saved for all AIS patients. Additionally, halving in-hospital time to treatment, i.e. improving EVT efficacy, led to a QALY gain of 0.04 and lifetime savings of €221.06 per patient, resulting in total savings of €58M.

CONCLUSIONS: The most impactful improvements in enhancing the cost-effectiveness of AIS care pathways vary by country, due to differences in healthcare systems and resource allocation. Our model provides a valuable adaptable tool for policy- and decision makers to evaluate and optimize AIS care pathways across diverse settings, potentially leading to significant economic and health benefits. Our study highlights the importance of targeted improvements in AIS care pathways.