Gao Lan, Moodie Marj, Yassi Nawaf, Davis Stephen M, Bladin Christopher F, Smith Karen, Bernard Stephen, Stephenson Michael, Churilov Leonid, Campbell Bruce C V, Zhao Henry
Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, VIC, Australia.
Department of Medicine and Neurology, Melbourne Brain Centre at The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.
Front Neurol. 2022 May 13;13:871999. doi: 10.3389/fneur.2022.871999. eCollection 2022.
Pre-hospital severity-based triaging using the Ambulance Clinical Triage For Acute Stroke Treatment (ACT-FAST) algorithm has been demonstrated to substantially reduce time to endovascular thrombectomy in Melbourne, Australia. We aimed to model the cost-effectiveness of an ACT-FAST bypass system from the healthcare system perspective.
A simulation model was developed to estimate the long-term costs and health benefits associated with diagnostic accuracy of the ACT-FAST algorithm. Three-month post stroke functional outcome was projected to the lifetime horizon to estimate the long-term cost-effectiveness between two strategies (ACT-FAST vs. standard care pathways). For ACT-FAST screened true positives (i.e., screened positive and eligible for EVT), a 52 mins time saving was applied unanimously to the onset to arterial time for EVT, while 10 mins delay in thrombolysis was applied for false-positive (i.e., screened positive but was ineligible for EVT) thrombolysis-eligible infarction. Quality-adjusted life year (QALY) was employed as the outcome measure to calculate the incremental cost-effectiveness ratio (ICER) between the ACT-FAST algorithm and the current standard care pathway.
Over the lifetime, ACT-FAST was associated with lower costs (-$45) and greater QALY gains (0.006) compared to the current standard care pathway, resulting in it being the dominant strategy (less costly but more health benefits). Implementing ACT-FAST triaging led to higher proportion of patients received EVT procedure (30 more additional EVT performed per 10,000 patients). The total Net Monetary Benefit from ACT-FAST care estimated at A$0.76 million based on its implementation for a single year.
An ACT-FAST severity-triaging strategy is associated with cost-saving and increased benefits when compared to standard care pathways. Implementing ACT-FAST triaging increased the proportion of patients who received EVT procedure due to more patients arriving at EVT-capable hospitals within the 6-h time window (when imaging selection is less rigorous).
在澳大利亚墨尔本，使用急性卒中治疗的救护车临床分诊（ACT-FAST）算法进行基于院前严重程度的分诊已被证明可大幅缩短血管内血栓切除术的时间。我们旨在从医疗保健系统的角度对ACT-FAST分流系统的成本效益进行建模。
开发了一个模拟模型，以估计与ACT-FAST算法的诊断准确性相关的长期成本和健康效益。将卒中后三个月的功能结局推算至终身，以估计两种策略（ACT-FAST与标准护理途径）之间的长期成本效益。对于ACT-FAST筛查出的真阳性（即筛查阳性且符合血管内血栓切除术条件），统一将52分钟的时间节省应用于血管内血栓切除术的发病至动脉开通时间，而对于假阳性（即筛查阳性但不符合血管内血栓切除术条件）且符合溶栓条件的梗死患者，溶栓延迟10分钟。采用质量调整生命年（QALY）作为结局指标，计算ACT-FAST算法与当前标准护理途径之间的增量成本效益比（ICER）。
在整个生命周期内，与当前标准护理途径相比，ACT-FAST的成本更低（-45美元），QALY增益更大（0.006），因此它是主导策略（成本更低但健康效益更高）。实施ACT-FAST分诊导致接受血管内血栓切除术的患者比例更高（每10,000名患者多进行30例血管内血栓切除术）。根据ACT-FAST护理实施一年的情况，估计其总净货币效益为76万澳元。
与标准护理途径相比，ACT-FAST严重程度分诊策略具有成本节约和效益增加的特点。实施ACT-FAST分诊增加了接受血管内血栓切除术的患者比例，因为更多患者在6小时时间窗内（此时影像选择要求较低）到达具备血管内血栓切除术能力的医院。
