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Objective: This study was undertaken to examine averted stroke in optimized stroke systems. Methods: This secondary analysis of a multicenter trial from 2014 to 2020 compared patients treated by mobile stroke unit (MSU) versus standard management. The analytical cohort consisted of participants with suspected stroke treated with intravenous thrombolysis. The main outcome was a tissue‐defined averted stroke, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis and no acute infarction/hemorrhage on imaging. An additional outcome was stroke with early symptom resolution, defined as a final diagnosis of stroke with resolution of presenting symptoms/signs by 24 hours attributed to thrombolysis. Results: Among 1,009 patients with a median last known well to thrombolysis time of 87 minutes, 159 (16%) had tissue‐defined averted stroke and 276 (27%) had stroke with early symptom resolution. Compared with standard management, MSU care was associated with more tissue‐defined averted stroke (18% vs 11%, adjusted odds ratio [aOR] = 1.82, 95% confidence interval [CI] = 1.13–2.98) and stroke with early symptom resolution (31% vs 21%, aOR = 1.74, 95% CI = 1.12–2.61). The relationships between thrombolysis treatment time and averted/early recovered stroke appeared nonlinear. Most models indicated increased odds for stroke with early symptom resolution but not tissue‐defined averted stroke with earlier treatment. Additionally, younger age, female gender, hyperlipidemia, lower National Institutes of Health Stroke Scale, lower blood pressure, and no large vessel occlusion were associated with both tissue‐defined averted stroke and stroke with early symptom resolution. Interpretation: In optimized stroke systems, 1 in 4 patients treated with thrombolysis recovered within 24 hours and 1 in 6 had no demonstrable brain injury on imaging. ANN NEUROL 2024;95:347–361 [ABSTRACT FROM AUTHOR]

Objective Methods Results Interpretation Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost‐effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost‐effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS).This study is a prospective, multicenter, alternating‐week, cluster‐controlled trial of MSU versus EMS. One‐year and life‐time cost‐effectiveness analyses, using the incremental cost‐effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality‐adjusted life years (QALYs) estimated using patient‐reported EQ‐5D‐5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre‐existing disability, and limited to stroke‐related costs were also calculated.The first‐year ICER for all tPA‐eligible patients using total cost differences between MSU and EMS groups was $238,873/QALY; for patients without pre‐existing disability was $61,199/QALY. The lifetime ICERs for all tPA‐eligible patients and for those without pre‐existing disability were $94,710 and $31,259/QALY, respectively. All ICERs were lower when restricted to stroke‐related costs and were highly dependent on the number of patients treated per year in an MSU.MSUs' cost‐effectiveness is borderline if we consider total first‐year costs and outcomes in all tPA‐eligible patients. MSUs are cost‐effective to highly cost‐effective when calculations are based on patients without pre‐existing disability, patients' lifetime horizon, stroke‐related costs, and more patients treated per year in an MSU. ANN NEUROL 2024 [ABSTRACT FROM AUTHOR]