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Lookup NU author(s): Dr Nawaraj Bhattarai,
Professor Christopher Price,
Dr Paul McMeekin,
Dr Mehdi Javanbakht,
Professor Luke Vale,
Professor Gary Ford,
Dr Lisa Shaw
This is the authors' accepted manuscript of an article that has been published in its final definitive form by Sage Publications Ltd., 2021.
For re-use rights please refer to the publisher's terms and conditions.
© 2021 World Stroke Organization.Background: The Paramedic Acute Stroke Treatment Assessment (PASTA) trial evaluated an enhanced emergency care pathway which aimed to facilitate thrombolysis in hospital. A pre-planned health economic evaluation was included. The main results showed no statistical evidence of a difference in either thrombolysis volume (primary outcome) or 90-day dependency. However, counter-intuitive findings were observed with the intervention group showing fewer thrombolysis treatments but less dependency. Aims: Cost-effectiveness of the PASTA intervention was examined relative to standard care. Methods: A within trial cost-utility analysis estimated mean costs and quality-adjusted life years over 90 days’ time horizon. Costs were derived from resource utilization data for individual trial participants. Quality-adjusted life years were calculated by mapping modified Rankin scale scores to EQ-5D-3L utility tariffs. A post-hoc subgroup analysis examined cost-effectiveness when trial hospitals were divided into compliant and non-compliant with recommendations for a stroke specialist thrombolysis rota. Results: The trial enrolled 1214 patients: 500 PASTA and 714 standard care. There was no evidence of a quality-adjusted life year difference between groups [0·007 (95% CI: −0·003 to 0·018)] but costs were lower in the PASTA group [−£1473 (95% CI: −£2736 to −£219)]. There was over 97.5% chance that the PASTA pathway would be considered cost-effective. There was no evidence of a difference in costs at seven thrombolysis rota compliant hospitals but costs at eight non-complaint hospitals costs were lower in PASTA with more dominant cost-effectiveness. Conclusions: Analyses indicate that the PASTA pathway may be considered cost-effective, particularly if deployed in areas where stroke specialist availability is limited. Trial Registration: ISRCTN12418919 www.isrctn.com/ISRCTN12418919
Author(s): Bhattarai N, Price CI, McMeekin P, Javanbakht M, Vale L, Ford GA, Shaw L
Publication type: Article
Publication status: Published
Journal: International Journal of Stroke
Pages: ePub ahead of print
Online publication date: 16/03/2021
Acceptance date: 20/02/2021
Date deposited: 25/03/2021
ISSN (print): 1747-4930
ISSN (electronic): 1747-4949
Publisher: Sage Publications Ltd.
PubMed id: 33724103
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