Abstract WP117: Reducing pre-hospital delay to improve outcomes for acute ischemic stroke versus implementing recommended stroke prevention strategies in type 2 diabetes patients: a cost-effective analysis

Introduction: Reducing the time before hospital treatment begins can improve acute ischemic stroke (AIS) outcomes. Objectives: To assess the cost-effectiveness of reducing pre-hospital delay in AIS treatment versus implementing recommended stroke prevention strategies in U.S. adults with type 2 diabetes (T2D). Methods: Based on National Health and Nutrition Examination Survey data from 2015-2018, we identified individuals with T2D ≥45 years of age without stroke history. We simulated stroke events, stroke-related quality-adjusted life years (QALYs), and healthcare costs for this population over 10 years using a microsimulation model, the Michigan Model for Diabetes. We compared two enhanced scenarios versus the status-quo. The status-quo assumes that 50% of stroke patients arrive within 24 hours of stroke onset (28% within 3.5 hours) and that the level of implementation of guideline recommended primary stroke prevention strategies was at the average national level observed in 2015-2018. In the first enhanced scenario, we assumed that among those arriving within 24 hours, 100% arrived within 3.5 hours. The second enhanced scenario assumes all individuals implement four stroke prevention strategies (well controlled BP, aspirin treatment, statin treatment, and smoking cessation) as soon as they became eligible. Sensitivity analyses were conducted to study less optimal scenarios. Analyses were performed from a health system/payer perspective. Results: Over 10 years, shortening hospital arrival time would be highly cost-effective, averting 10,900 cases of stroke-related major disability, 6,700 deaths from stroke, and producing a nationwide increase of 12,000 QALYs (Net Health Benefit [NHB]), at a cost of $6.3 billion. Full implementation of guideline-recommended medical therapies would prevent 68,900 cases of stroke-related major disability, 62,200 deaths from stroke, and produce a nationwide increase of 1,552,000 QALYs (NHB) while saving $13 billion ( Table 1 ). Results from the sensitivity analyses are consistent with the main results. Conclusions: Although reducing pre-hospital delays for stroke treatment can be cost-effective, enhancing primary prevention of AIS in the population with T2D would result in a NHB 129 times greater. Providers and payers should prioritize adherence to guidelines for blood pressure management, statin and aspirin therapy, and smoking cessation to prevent strokes.