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HTA on prehospital CT for early diagnosis and treatment of suspected acute stroke in Norway
In June 2019, the Norwegian Institute of Public Health (NIPH) has released a health technology assessment report for prehospital CT for early diagnosis and treatment of suspected acute stroke or severe head injury, which aimed to summarize and evaluate the documentation for the clinical efficacy and safety of prehospital CT in case of suspected stroke or severe head injuries, and possible initiation of treatment prior to arrival in hospitals, compared with current practice where both imaging and treatment are done in hospitals.
NIPH came to the following conclusions:
- Compared with conventional care of acute stroke, mobile stroke unit (MSU) care probably reduces the time from a patient’s first contact with the emergency dispatch center to thrombolysis and increases the number of patients who receive thrombolysis. It may also lead to reduced time from a patient’s first contact with the emergency dispatch center to CT imaging, and to a better functionality at 3 months after stroke (mRS score 0-3)
- With an absolute shortfall of 5.5 QALYs, the argument for giving extra priority to introducing MSU care based on severity is weak-medium, and the societal willingness to pay for MSU according to the suggestion of the Magnussen group can be assumed to be around 385,000 Norwegian kroner per QALY. It was found that the expected cost per QALY is about 385,000 Norwegian kroner or lower if one MSU successfully reaches at least 35-40% (145-171) of thrombolysis patients per year. Decision makers must consider whether they think it is plausible that a minimum of 35-40% of patients could receive the intervention
- Due to the lack of evidence, the effectiveness of decentralized CT stations outside hospitals and of prehospital CT in suspected severe head injuries is unknown
See the full health technology assessment report in English and Norwegian here.
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