OBJECTIVES: A drive-the-doctor (DD) paradigm, where an interventionalist travels from comprehensive stroke centers (CSCs) to primary stroke centers (PSCs) to perform endovascular thrombectomy for acute ischemic stroke due to large vessel occlusion (LVO), reduces time delays from onset to recanalization. This study aimed to analyze cost-effectiveness of the DD paradigm versus current practice, where LVO patients are transferred from a PSC to a CSC for EVT in the Northern Netherlands.

METHODS: A cost-effectiveness model, including a simulation part, a decision tree and a Markov model, was developed to simulate costs and quality-adjusted life years (QALY) over a 10-year time horizon from a Dutch healthcare provider perspective. An incremental cost-effectiveness ratio (ICER) of €50,000 was used as an accepted willingness to pay threshold. In addition, one-way sensitivity, probabilistic sensitivity, and scenario analyses were conducted to examine the uncertainty of input parameters.

RESULTS: The DD paradigm with two thrombectomy-capable stroke centers (TSCs) provided additional 0.20 QALYs at incremental costs of €3,330, yielding an ICER of €16,803 compared to current practice. The DD paradigm with two TSCs was the optimal strategy in 94.3% of 10,000 Monte Carlo simulations at €50,000/QALY.

CONCLUSIONS: The DD paradigm was cost-effective for LVO patients in the North of the Netherlands and should be considered a promising alternative for organizing a regional stroke network.