Evidence map›Paper›PMID 33172878›Full record

ArticleEmergency medicine journal : EMJ2021

Secondary transfer of emergency stroke patients eligible for mechanical thrombectomy by air in rural England: economic evaluation and considerations.

Diarmuid Coughlan, Peter McMeekin, Darren Flynn, Gary A Ford, Hannah Lumley, David Burgess, Joyce Balami, Andrew Mawson, Dawn Craig, Stephen Rice and 1 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Emergency medicine journal : EMJ, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed, 1 pooled it
1.2field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

9 citing papers in PubMed, 1 synthesis or guideline pooled it, 16 citations in OpenAlex.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 6 institutions in 1 country.

Diarmuid CoughlanPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.ORCID http://orcid.org/0000-0002-5348-3750
Peter McMeekinFaculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK.
Darren FlynnSchool of Health and Social Care, Teesside University, Middlesbrough, UK.
Gary A FordOxford University Hospitals NHS Trust, Oxford, UK.
Hannah LumleyInstitute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK.ORCID http://orcid.org/0000-0003-1480-0001
David BurgessNorth East and North Cumbria Stroke Patient & Carer Panel, Newcastle upon Tyne, UK.
Joyce BalamiKellogg College, University of Oxford, Oxford, UK.
Andrew MawsonGreat North Air Ambulance, Northumberland Wing, The Imperial Centre, Darlington, UK.
Dawn CraigPopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Stephen RicePopulation Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Phil WhiteInstitute of Neuroscience (Stroke Research Group), Newcastle University, Newcastle upon Tyne, UK phil.white@newcastle.ac.uk.
Newcastle University · GBAcademic Health Science Network North East and North Cumbria · GBNorthumbria University · GBOxford University Hospitals NHS Trust · GBTeesside University · GBUniversity of Oxford · GB

Funding

Department of Health RP-PG-1211-20012
6 · The paper itself

Abstract

backgroundMechanical thrombectomy (MT) is a time-sensitive emergency procedure for patients who had ischaemic stroke leading to improved health outcomes. Health systems need to ensure that MT is delivered to as many patients as quickly as possible. Using decision modelling, we aimed to evaluate the cost-effectiveness of secondary transfer by helicopter emergency medical services (HEMS) compared with ground emergency medical services (GEMS) of rural patients eligible for MT in England.

methodsThe model consisted of (1) a short-run decision tree with two branches, representing secondary transfer transportation strategies and (2) a long-run Markov model for a theoretical population of rural patients with a confirmed ischaemic stroke. Strategies were compared by lifetime costs: quality-adjusted life years (QALYs), incremental cost per QALY gained and net monetary benefit. Sensitivity and scenario analyses explored uncertainty around parameter values.

resultsWe used the base case of early-presenting (<6 hours to arterial puncture) patient aged 75 years who had stroke to compare HEMS and GEMS. This produced an incremental cost-effectiveness ratio (ICER) of £28 027 when a 60 min reduction in travel time was assumed. Scenario analyses showed the importance of the reduction in travel time and futile transfers in lowering ICERs. For late presenting (>6 hours to arterial puncture), ground transportation is the dominant strategy.

conclusionOur model indicates that using HEMS to transfer patients who had stroke eligible for MT from remote hospitals in England may be cost-effective when: travel time is reduced by at least 60 min compared with GEMS, and a £30 000/QALY threshold is used for decision-making. However, several other logistic considerations may impact on the use of air transportation.

Indexed as

AgedAir AmbulancesAircraftDecision TreesEnglandFemaleHumansMaleMarkov ChainsModels, EconomicPatient TransferQuality-Adjusted Life YearsStrokeThrombectomyemergency ambulance systemsemergency care systemshelicopter retrievalmanagementremote and rural medicinestrokethromboembolic diseasex

Identifiers

PMID33172878
PMCPMC7788185
OpenAlexW3093216043

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.