Evidence map›Paper›PMID 39506352›Full record

ArticleEuropean journal of neurology2025

Mobile stroke units services in Germany: A cost-effectiveness modeling perspective on catchment zones, operating modes, and staffing.

Johann S Rink, Kristina Szabo, Carolin Hoyer, Jeffrey L Saver, May Nour, Heinrich J Audebert, Wolfgang G Kunz, Matthias F Froelich, Armin Heinzl, Andrej Tschalzev and 3 more

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In one paragraph

Article in European journal of neurology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

6 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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  3. Article
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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

13 authors.

Johann S RinkDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.ORCID 0000-0002-7069-5181
Kristina SzaboDepartment of Neurology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.ORCID 0000-0002-0465-818X
Carolin HoyerDepartment of Neurology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.ORCID 0000-0001-5672-0865
Jeffrey L SaverDepartment of Neurology, UCLA Stroke Center, University of California, Los Angeles, California, USA.
May NourDepartments of Neurology and Radiology, Ronald Reagan UCLA Medical Center, Los Angeles, California, USA.
Heinrich J AudebertDepartment of Neurology and Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.
Wolfgang G KunzDepartment of Radiology, University Hospital, LMU Munich, Munich, Germany.
Matthias F FroelichDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Armin HeinzlUniversity of Mannheim, Mannheim, Germany.
Andrej TschalzevInstitute for Enterprise Systems, University of Mannheim, Mannheim, Germany.
Jens HoffmannDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Stefan O SchoenbergDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Fabian TollensDepartment of Radiology and Nuclear Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.

Funding

German Federal Ministry for Digital and Transport 45FGU140_F
6 · The paper itself

Abstract

background and purposeInvestigating the cost-effectiveness of future mobile stroke unit (MSU) services with respect to local idiosyncrasies is essential for enabling large-scale implementation of MSU services. The aim of this study was to assess the cost-effectiveness for varying urban German settings and modes of operation.

methodsCosts of different operating times together with different personnel configurations were simulated. Different possible catchment zones, ischemic stroke incidence, circadian distribution, rates of alternative diagnoses, as well as missed cases were incorporated to model case coverage and patient numbers. Based on internationally reported clinical outcomes of MSUs, a 5-year Markov model was applied to analyze the cost-effectiveness for the different program setups.

resultsCompared with standard stroke care, MSUs achieved an additional 0.06 quality-adjusted life years (QALYs) over a 5-year time horizon. Assuming a catchment zone of 750,000 inhabitants and 8 h/7 day operation resulted in an incremental cost-effectiveness ratio (ICER) of €37,182 per QALY from a societal perspective and €45,104 per QALY from a healthcare perspective. Lower ICERs were possible when coverage was expanded to 16 h service on 7 days per week and larger populations. Sensitivity analyses revealed that missing ischemic strokes significantly deteriorated economic performance of MSU.

conclusionsMajor determinants of cost-effectiveness should be addressed when setting up novel MSU programs. Catchment zones of more than 500,000-700,000 inhabitants and operating times of at least 12-16 h per day, 7 days per week could enable the most cost-effective MSU services in the German healthcare system.

Indexed as

Cost-Benefit AnalysisMobile Health UnitsStrokeCatchment Area, HealthGermanyHumansMarkov ChainsQuality-Adjusted Life Yearsacute stroke careacute stroke therapycomputed tomographyeconomic evaluationmobile stroke unittelemedicine

Identifiers

PMID39506352
PMCPMC11622509

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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.