Optimal Transport Scenario for Access to EVT with Consideration of Patient Outcomes and Cost

Abstract

There are two treatments for ischemic stroke: medical treatment (tPA) and endovascular therapy (EVT). EVT can only be used to treat ischemic strokes caused by a large vessel occlusion (LVO). EVT is only offered at hospitals with sufficient resources. A previously published model predicts the outcome of patient’s who screen positive for an LVO based on how they were transported, Drip and Ship (tPA only facility first, then EVT facility) or Mothership (direct to EVT facility). Both patient outcome and transport cost functions were developed for these strategies. The addition of rotary wing transportation was conditionally applied to inter-facility transfer scenarios where it provided a time advantage. In most regions, both outcome and cost can be optimized to indicate whether Drip and Ship or Mothership is preferred. Regions exist where outcome and cost are divergent however, the difference between Mothership and Drip and Ship in these regions is marginal.