TY - JOUR
T1 - Low-intensity monitoring for mild-to-moderate acute ischemic stroke is cost saving
T2 - economic evaluation for OPTIMISTmain
AU - Xu, Lizheng
AU - Ouyang, Menglu
AU - Atkins, Emily R.
AU - Summers, Debbie
AU - Sui, Yi
AU - Johnson, Brenda
AU - Billot, Laurent
AU - Malavera, Alejandra
AU - Faigle, Roland
AU - Muñoz-Venturelli, Paula
AU - Day, Diana
AU - Liu, Xiaoqiu
AU - Li, Qiang
AU - Song, Lili
AU - Robinson, Thompson G.
AU - González, Francisca
AU - Urrutia-Goldsack, Francisca
AU - Delcourt, Candice
AU - Nguyen, Huy Thang
AU - Ton, Mai Duy
AU - Liu, Hueiming
AU - Lindley, Richard I.
AU - Arauz, Antonio
AU - Mercado, Andrés
AU - Wan Zaidi, Wan Asyraf
AU - Khatri, Pooja
AU - Wang, Xia
AU - Urrutia, Victor C.
AU - Jan, Stephen
AU - Anderson, Craig S.
PY - 2026/3
Y1 - 2026/3
N2 - BACKGROUND: – OPTIMISTmain (Main Optimal Post rtPA-IV Monitoring in Ischemic Stroke Trial) has shown that low-intensity monitoring is feasible and safe compared with standard monitoring in stable patients who receive thrombolysis treatment for acute ischemic stroke of mild-to-moderate neurological impairment. We aimed to estimate the economic benefits of low-intensity care compared with standard care. METHODS: – A cost-minimization analysis based on OPTIMISTmain was conducted for Australia, China, Malaysia, the United Kingdom, the United States, and Vietnam. A decision tree model comprising 2 arms was developed from the trial design. State transition probabilities for each country were extracted from the trial, and cost data were sourced from the existing literature. Mean costs over the 90-day duration of follow-up were compared, and univariate and probabilistic sensitivity and scenario analyses were performed. RESULTS: – Low-intensity monitoring had the highest probability of cost saving in China (100.00%) and the United Kingdom (100.00%), followed by Australia (99.94%), the United States (95.91%), and Vietnam (86.66%), as patients in this group incurred US dollars savings of 239, 133, 647, 943, and 3 in direct costs compared with patients in the standard group, respectively. In Malaysia, however, the intervention costs slightly exceeded those for standard care (US dollars 5643 versus 5378). Countries with higher proportions of patients having intensive care unit monitoring had greater cost savings. Cost-saving thresholds of monitoring costs were 1.24, 1.30, 1.26, 1.24, 1.01, and 0.91 times the base case value in Australia, China, the United Kingdom, the United States, Vietnam, and Malaysia, respectively. CONCLUSIONS: – The low-intensity monitoring protocol was cost saving in countries with high proportions of intensive care resources for postthrombolysis treatment monitoring, such as in the United States. REGISTRATION: – URL: https://www.clinicaltrials.gov; Unique identifier: NCT03734640. URL: https://www.anzctr.org.au/; Unique identifier: ACTRN 12619001556134p.
AB - BACKGROUND: – OPTIMISTmain (Main Optimal Post rtPA-IV Monitoring in Ischemic Stroke Trial) has shown that low-intensity monitoring is feasible and safe compared with standard monitoring in stable patients who receive thrombolysis treatment for acute ischemic stroke of mild-to-moderate neurological impairment. We aimed to estimate the economic benefits of low-intensity care compared with standard care. METHODS: – A cost-minimization analysis based on OPTIMISTmain was conducted for Australia, China, Malaysia, the United Kingdom, the United States, and Vietnam. A decision tree model comprising 2 arms was developed from the trial design. State transition probabilities for each country were extracted from the trial, and cost data were sourced from the existing literature. Mean costs over the 90-day duration of follow-up were compared, and univariate and probabilistic sensitivity and scenario analyses were performed. RESULTS: – Low-intensity monitoring had the highest probability of cost saving in China (100.00%) and the United Kingdom (100.00%), followed by Australia (99.94%), the United States (95.91%), and Vietnam (86.66%), as patients in this group incurred US dollars savings of 239, 133, 647, 943, and 3 in direct costs compared with patients in the standard group, respectively. In Malaysia, however, the intervention costs slightly exceeded those for standard care (US dollars 5643 versus 5378). Countries with higher proportions of patients having intensive care unit monitoring had greater cost savings. Cost-saving thresholds of monitoring costs were 1.24, 1.30, 1.26, 1.24, 1.01, and 0.91 times the base case value in Australia, China, the United Kingdom, the United States, Vietnam, and Malaysia, respectively. CONCLUSIONS: – The low-intensity monitoring protocol was cost saving in countries with high proportions of intensive care resources for postthrombolysis treatment monitoring, such as in the United States. REGISTRATION: – URL: https://www.clinicaltrials.gov; Unique identifier: NCT03734640. URL: https://www.anzctr.org.au/; Unique identifier: ACTRN 12619001556134p.
KW - cost-benefit analysis
KW - ischemic stroke
KW - nursing care
KW - patient discharge
KW - thrombolytic therapy
UR - https://www.scopus.com/pages/publications/105029372066
U2 - 10.1161/STROKEAHA.125.053506
DO - 10.1161/STROKEAHA.125.053506
M3 - Article
C2 - 41608808
AN - SCOPUS:105029372066
SN - 0039-2499
VL - 57
SP - 587
EP - 596
JO - Stroke
JF - Stroke
IS - 3
ER -