Background and Aims: Reconfiguring hyperacute stroke services to yield the maximum benefit from time-critical treatments (thrombolysis [IVT] and thrombectomy [MT]) is a policy priority for many countries, including the UK. Methods: We used outcome data from individual patient metanalyses of IVT and MT to construct a computer simulation model of hyperacute stroke care for the 1.9 million population of Northern Ireland (~2,800 strokes/year). We used a comprehensive search algorithm that sought solutions that maximised disability benefit (numbers of people with stroke with little or no residual disability at 90 days) balanced against other competing factors eg. institutional size, and mapped the outputs. Results: The greatest population benefit (a two-fold increase) accrued from driving significant improvements in existing door-to-treatment times and treatment rates. Subsequent models identified an approximately equivalent degree of population benefit from a range of solutions based on the present 8 centres to as few as 3,4 or 5 IVT centres, one of which provides MT. Median travel times to an IVT centre were 17 minutes for the current state, and 28 minutes for 3 centres; travel times to the MT centre fell from 100 minutes to 82 mins. Reconfiguration resulted in fewer, larger centres with between 520 and 1,613 admissions with acute stroke/year. Conclusions: Policy decisions regarding stroke service reconfigurations intended to maximise benefit from time-sensitive treatment in specialist centres can be usefully illuminated by computer simulation using outcome data from randomised trials. This approach has extensive potential to support policy-making and public debate, particularly regarding the development of new thrombectomy capacity.
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