• Dorte Gyrd-Hansen, Kim Rose Olsen, Kerstin Bollweg, Christian Kronborg, Martin Ebinger, and Heinrich J Audebert.
• From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany. dgh@sam.sdu.dk.
• Neurology. 2015 Mar 17;84(11):1090-7.

ObjectiveTo analyze the cost-effectiveness of shorter delays to treatment and increased thrombolysis rate as shown in the PHANTOM-S (Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke) Study.MethodsIn addition to intermediate outcomes (time to thrombolysis) and treatment rates, we registered all resource consequences of the intervention. The analyzed treatment effects of the intervention were restricted to distribution of IV thrombolysis (IVT) administrations according to time intervals. Intermediate outcomes were extrapolated to final outcomes according to numbers needed to treat derived from pooled IVT trials and translated to gains in quality-adjusted life-years (QALYs).ResultsThe net annual cost of the Stroke Emergency Mobile (STEMO) prehospital stroke concept was €963,954. The higher frequency of IVT administrations per year (310 vs 225) and higher proportions of patients treated in the early time interval (within 90 minutes: 48.1% vs 37.4%; 91-180 minutes: 37.4% vs 50%; 181-270 minutes: 14.5% vs 12.8%) resulted in an annual expected health gain of avoidance of 18 cases of disability equaling 29.7 QALYs. This produced an incremental cost-effectiveness ratio of €32,456 per QALY.ConclusionsDepending on willingness-to-pay thresholds in societal perspectives, the STEMO prehospital stroke concept has the potential of providing a reasonable innovation even in health-economic dimensions.© 2015 American Academy of Neurology.

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