Cost-effectiveness of helicopter transport of stroke patients for thrombolysis

Objectives: Treatment with intravenous (IV) or intra-arterial (IA) thrombolysis in patients with acute ischemic stroke demands careful patient selection and specialized institutional capabilities. Physicians at hospitals without these resources may prefer patient transfer for acute treatment. Helicopter transport for these patients has been described but without analysis of the effects of its additional cost. The authors examined the cost-effectiveness of helicopter transport for patients with acute stroke. Methods: Costs per additional good outcome and per quality-adjusted life-year (QALY) were calculated using a computer model. Input variables included flight, thrombolytic agent, and angiography costs; annual cost per patient for long-term care of symptomatic stroke; percentage of transported patients treated; percentage of patients receiving IV versus IA therapy; discount rate; absolute probability of good outcome; annual mortality with and without treatment, and quality-of-life modifier. Sensitivity analysis was performed. Results: Helicopter transport of acute stroke patients to tertiary care centers for thrombolytic therapy costs $35,000 per additional good outcome and $3,700 per QALY for the reference case. Cost-effectiveness was sensitive to the effectiveness of thrombolysis but minimally sensitive to most other input values. Cost per QALY ranged from $0 to $50,000, as the absolute increase in good outcomes (minimal or no deficit) ranged from 20% to 5%. Cost-effectiveness was not sensitive to ranges of helicopter flight costs or the proportion of flown patients undergoing treatment. Conclusions: This model indicates helicopter transfer of patients with suspected acute ischemic stroke for potential thrombolysis is cost-effective for a wide range of system variables.