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Cost-effectiveness of an enhanced Paramedic Acute Stroke Treatment Assessment (PASTA) during emergency stroke care: economic results from a pragmatic cluster randomised trial

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

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This is the authors' accepted manuscript of an article that has been published in its final definitive form by Sage Publications Ltd., 2021.

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Abstract

© 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


Publication metadata

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

Year: 2021

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.

URL: https://doi.org/10.1177%2F17474930211006302

DOI: 10.1177%2F17474930211006302

PubMed id: 33724103


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