Evidence map›Paper›PMID 40627814›Full record

ArticleNeurology2025

A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.

Peter L van Hulst, Ruben M van de Wijdeven, Esmee Venema, Florentina M E Pinckaers, Myriam G M Hunink, Aad van der Lugt, Diederik W J Dippel, Hester F Lingsma, Daniel Bos, Bob Roozenbeek and 1 more

Abstract read
In one paragraph

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

0numbers the graph read from it
0cells of the map it votes in
1citing 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

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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.

Peter L van HulstDepartment of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0009-0009-9870-8931
Ruben M van de WijdevenDepartment of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
Esmee VenemaEmergency Department, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0003-1631-6635
Florentina M E PinckaersDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Center, the Netherlands.
Myriam G M HuninkDepartment of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0002-2942-2798
Aad van der LugtDepartment of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0002-6159-2228
Diederik W J DippelDepartment of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0002-9234-3515
Hester F LingsmaDepartment of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0003-2063-9533
Daniel BosDepartment of Radiology and Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0001-8979-2603
Bob RoozenbeekDepartment of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands.ORCID 0000-0002-8320-8303
ICAI Stroke Lab

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesMobile stroke units (MSUs) have the potential to improve functional outcome of ischemic stroke patients, through shortening onset-to-treatment times. Previous cost-effectiveness studies have limited generalizability to nonmetropolitan settings and did not evaluate cost-effectiveness over a lifetime horizon. We aimed to develop a regionally adaptable decision-analytic model, to evaluate cost-effectiveness of MSU implementation and to identify the optimal dispatch scenario.

methodsWe developed a generalizable state-transition microsimulation model with modifiable region-specific parameters and dispatch characteristics to evaluate the lifetime cost-effectiveness from a health care perspective of 1-year MSU implementation. We used the southwest of the Netherlands (1,770,000 inhabitants, 1,592 km

resultsIn the base case scenario, the MSU was dispatched to 2,080 of 3,628 patients (57.3%) with a suspected stroke and onset-to-alarm time <6 hours, resulting in a lifetime gain of 399 (95% CI 384-414) additional quality-adjusted life years, €3.9 million (95% CI €3.5 million-€4.3 million) cost savings, and an iNMB of €23.9 million (95% CI €22.8 million-€24.9 million). A smaller catchment area for MSU dispatch was associated with increased cost-effectiveness. DISCUSSION: Adding an MSU to the dispatch strategy for suspected stroke patients is expected to be cost-effective in our region. Our model facilitates evaluation of the cost-effectiveness of MSU implementation in different regions, settings, and scenarios with varying characteristics.

Indexed as

Cost-Benefit AnalysisDecision Support TechniquesEmergency Medical ServicesIschemic StrokeMobile Health UnitsStrokeAgedFemaleHumansMaleMiddle AgedNetherlands

Identifiers

PMID40627814
PMCPMC12239896

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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.