Clinical outcome and cost effectiveness of acute ischemic stroke transfers for endovascular reperfusion therapy from geographically distant counties: Stroke transfer outcomes

• Published in: Journal of stroke and cerebrovascular diseases 2024-11, Vol.33 (11), p.107981
• Main Authors: Ray, Bappaditya, Mathews, Essie P, Hernandez, Roberto S, Glaser, Kimberly R, Washington, Heather H, Salter, Amber, Olson, DaiWai M, Aiyagari, Venkatesh
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Catchment Area, Health - economics; Cost-Benefit Analysis; Cost-Effectiveness Analysis; Disability Evaluation; Endovascular Procedures - adverse effects; Endovascular Procedures - economics; Female; Hospital Costs; Humans; Ischemic Stroke - diagnosis; Ischemic Stroke - economics; Ischemic Stroke - therapy; Male; Middle Aged; Patient Transfer - economics; Recovery of Function; Retrospective Studies; Thrombolytic Therapy - economics; Time Factors; Time-to-Treatment - economics; Treatment Outcome
• ISSN: 1532-8511; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2024.107981

Endovascular reperfusion therapy (EVT) for acute ischemic stroke (AIS) with large vessel occlusion (LVO) has resulted in increased patient transfers to comprehensive stroke centers (CSCs). Clinical outcomes including the financial impact of these transfers from geographically dispersed population are lacking. Hence, we studied outcomes and cost-effectiveness of stroke transfers from remote areas. We used a 3-year cohort of AIS patients transferred from geographically dispersed counties (200 mi.). A 3-month modified Rankin scale (mRS) score of 0-2 defined a favorable clinical outcome. Cost-effectiveness is studied by calculating the incremental cost effectiveness ratio, using hospital costs reimbursed data and utility-weighted (UW)-mRS. Among 172 patients transferred for EVT, patients transferred from nearby counties were more likely to undergo intervention compared to other counties (56.9 % vs. 36.7 % vs. 49.2 % p = .11). Irrespective of proximity (in mi.) to CSC [21.5 (14-56.3)] vs. 185 (137-185) vs. 349 (325-355)], there was a similar delay (in min.) to arrival from all locations [321.5 (244-490), 366 (298-432), and 460 (385-554.5) respectively], but no statistically significant differences in favorable outcomes (18.0 %, 34.1 %, and 22.2 %, respectively, p = .41). Patients undergoing EVT had higher hospital costs reimbursed compared to non-EVT patients [$37,303 (25,745-40,658) vs. $14,008 (8,640-21,273) respectively, p < .001] and no statistically significant difference in UW-mRS [0.32 (0.06-0.56) vs. 0.06 (0-0.56), p = .30]. Our study identifies a need for targeted interventions to improve community awareness and optimize systems of care to improve outcomes and cost-effectiveness of EVT.