Abstract WP90: Cost of Stroke Treatment: A Comparative Analysis of Mobile Stroke and Standard Treatment

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Introduction: Over the past decade, Mobile Stroke Treatment Units (MSTU) have enhanced the quality of stroke care in the United States by bringing the hospital to the patient. While MSTUs improve stroke patient outcomes compared to standard hospital care, there are still limited units operating. The implementation of a MSTU requires considerable initial and long-term investment limiting their widespread programmatic formation. We evaluated a MSTU program in Florida between August 2023 and April 2024 for comparative patient associated out of pocket costs with MSTU and standard stroke care. Methods: A discrete time Markov Chain Monte Carlo (MCMC) model was used to estimate incremental cost-savings associated with MSTU treatment compared to standard hospital care. The Markov model captured treatment costs for the care of patients at two functional levels as defined by the modified Rankin Scale (mRS). The potential cost-savings was determined by comparing the estimated costs incurred by the MSTU cohort to a counterfactual scenario of standard care of Emergency Medical Services (EMS) transport to the Emergency Department (ED). Since the model focused on the cost of patient care, costs included only billed ED, inpatient, and outpatient hospital care and services provided in the baseline year and then estimated cost of care over the next four years. All values represent 2024 dollars ($) and a 3% discount rate was applied to years two through four. Results: The MSTU treated 59 acute stroke patients with an average age of 71.86 (SD=13.78). Overall, 76% (N=45) were diagnosed with ischemic stroke, 9% with intracerebral hemorrhage (ICH), and 15% with transient ischemic attack (TIA). At discharge, 54% were independent and 46% dependent. In Year 1 (baseline), out of pocket cost differential between MSTU patients and the standard care was estimated to be $5,306 and $6,485 for the independent and dependent patients respectively. Projected future cost differentials in Years 2 to 4 were $4,571, $3,845, and $2,817 for the independent functioning cohort and $5,586, $4,700, and $4,188 for the dependent functioning cohort. Conclusion: These results suggest that the out of pocket cost for MSTU patients was significantly lower than standard care both at baseline and over the first four years post-stroke, making MSTU acute stroke management a better economic system of care for time metrics, long term patient outcomes, and cost effectiveness.

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