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

Bhattarai, Nawaraj, Price, Christopher, McMeekin, Peter, Javanbakht, Mehdi, Vale, Luke, Ford, Gary A. and Shaw, Lisa (2022) Cost-effectiveness of an enhanced Paramedic Acute Stroke Treatment Assessment (PASTA) during emergency stroke care: Economic results from a pragmatic cluster randomized trial. International Journal of Stroke, 17 (3). pp. 282-290. ISSN 1747-4930

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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 (SC).
Methods: A within trial cost-utility analysis estimated mean costs and quality adjusted life years (QALYs) over 90 days’ time horizon. Cost were derived from resource utilisation data for individual trial participants. QALYs 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 SC. There was no evidence of a QALY 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

Item Type: Article
Additional Information: Funding information: The trial was funded by the National Institute for Health Research (Programme Grants for Applied Research, title: Promoting Effective and Rapid Stroke care (PEARS), project number: RP-PG-1211-20012). The views and opinions expressed here are those of the authors and do not necessarily reflect those of the NIHR or Department of Health and Social Care.
Uncontrolled Keywords: Stroke, Thrombolysis, ambulance, cluster randomised controlled trial, cost-effectiveness, paramedic
Subjects: B100 Anatomy, Physiology and Pathology
B700 Nursing
B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Elena Carlaw
Date Deposited: 25 Mar 2021 13:04
Last Modified: 29 Mar 2022 09:00

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