title: Cost-effectiveness estimate of prehospital thrombolysis: results of the PHANTOM-S study.
abstract: OBJECTIVE
  To 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.
  
  
  METHODS
  In 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).
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Depending 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.
authors: 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.
authors: Dorte
authors: D
authors: Gyrd-Hansen
authors: 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.
authors: Kim Rose
authors: KR
authors: Olsen
authors: 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.
authors: Kerstin
authors: K
authors: Bollweg
authors: 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.
authors: Christian
authors: C
authors: Kronborg
authors: 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.
authors: Martin
authors: M
authors: Ebinger
authors: 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.
authors: Heinrich J
authors: HJ
authors: Audebert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003362:Cost-Benefit Analysis / Q000379:methods*; D004632:Emergency Medical Services / Q000191:economics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy* / Q000191:economics*; D015912:Thrombolytic Therapy / Q000191:economics* / Q000379:methods; D061665:Time-to-Treatment; D055815:Young Adult