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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 BhattaraiORCiD, Professor Christopher PriceORCiD, Dr Paul McMeekin, Dr Mehdi JavanbakhtORCiD, Professor Luke ValeORCiD, 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

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.


DOI: 10.1177%2F17474930211006302

PubMed id: 33724103


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Funder referenceFunder name
RP-PG-1211-20012National Institute for Health Research (NIHR)