{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:26:58Z","timestamp":1791390418472,"version":"4.3.3"},"reference-count":42,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,12,3]],"date-time":"2024-12-03T00:00:00Z","timestamp":1733184000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Annals of Neurology"],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost\u2010effectiveness 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\u2010effectiveness 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).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study is a prospective, multicenter, alternating\u2010week, cluster\u2010controlled trial of MSU versus EMS. One\u2010year and life\u2010time cost\u2010effectiveness analyses, using the incremental cost\u2010effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality\u2010adjusted life years (QALYs) estimated using patient\u2010reported EQ\u20105D\u20105L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre\u2010existing disability, and limited to stroke\u2010related costs were also calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The first\u2010year ICER for all tPA\u2010eligible patients using total cost differences between MSU and EMS groups was $238,873\/QALY; for patients without pre\u2010existing disability was $61,199\/QALY. The lifetime ICERs for all tPA\u2010eligible patients and for those without pre\u2010existing disability were $94,710 and $31,259\/QALY, respectively. All ICERs were lower when restricted to stroke\u2010related costs and were highly dependent on the number of patients treated per year in an MSU.<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>MSUs' cost\u2010effectiveness is borderline if we consider total first\u2010year costs and outcomes in all tPA\u2010eligible patients. MSUs are cost\u2010effective to highly cost\u2010effective when calculations are based on patients without pre\u2010existing disability, patients' lifetime horizon, stroke\u2010related costs, and more patients treated per year in an MSU. 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