Eur Stroke J. 2026 May 6;11(5):aakag041. doi: 10.1093/esj/aakag041.
ABSTRACT
INTRODUCTION: Acute ischemic stroke (AIS) is a leading cause of disability and mortality worldwide, resulting in a significant economic burden. The European Stroke Action Plan set targets to improve stroke care, but substantial variation persists across countries.
PATIENTS AND METHODS: A decision-analytic model was developed. By comparing baseline performance in stroke care, based on data from 2015 to 2020, with the performance when meeting targets set on incidence, time and access to treatment and prevention, we estimated the potential clinical and economic impact in 7 European countries. The primary outcome was the incremental cost-effectiveness ratio, based on costs and quality-adjusted life-years (QALYs); secondary outcomes included disability (modified Rankin Scale; mRS).
RESULTS: Achieving the targets produced meaningful health gains in all countries, with several scenarios being dominant. Reducing stroke incidence had the greatest overall impact. Among the remaining targets, shorter time to treatment was dominant in France, Italy and the United Kingdom, and consistently reduced disability across countries (0.9%-14.3% point decreases in patients with mRS 3-5). Increasing endovascular treatment rates showed the greatest effect in Sweden and Spain and remained cost-effective elsewhere (€1823-€5331 per QALY gained). Reducing recurrent stroke delivered the largest cost savings in the Netherlands and the United Kingdom (€436 and €483 per patient, respectively) whilst generating QALY gains.
CONCLUSION: Although reducing stroke incidence yields the greatest overall benefit, optimal strategies differ between countries. Tailored approaches addressing country-specific care gaps will be essential to maximise health gains, reduce disability and improve economic efficiency of stroke care.
PMID:42153761 | DOI:10.1093/esj/aakag041