One-way sensitivity analysis results (ICERs for MRI-based strategy vs. no treatment).

<p>Tornado diagram summarizing one-way sensitivity analyses for the MRI-based strategy compared to the no treatment strategy for the base-case analysis. Most incremental cost-effectiveness ratios (ICERs) were close to the base-case result ($88,000/QALY) as model parameters were varied through plausible ranges, with the exceptions of the odds ratio of mRS0-1 with treatment for patients with stroke onset time 271–360 minutes, utility values for mRS5 and mRS4 health states, age in years, and MRI specificity. Parameters are shown in descending order of influence on model results.</p

Time sequence from sleep start to tissue-type plasminogen activator (tPA) initiation for acute wakeup stroke patients in the micro-simulation model.

<p>*Door-to-needle time includes additional 30 minutes for performing and interpreting MRI. **Base-case assumption for true stroke onset during sleep is based on a uniform probability between 0–8 hours. Sleep durations of 4 and 6 hours, and alternative skewed beta distributions used in sensitivity analyses.</p

Cost-effectiveness acceptability curve from probabilistic sensitivity analysis.

<p>The probability of the MRI-based strategy and no treatment strategy being cost-effective plotted against the cost-effectiveness threshold. The probability of a strategy being cost-effective was based on the probabilistic sensitivity analysis, which incorporates the uncertainty of all model parameters.</p

Two-way sensitivity analysis results for MRI sensitivity and specificity (for identifying stroke onset time of <4.5 hours), assuming willingness-to-pay for health of $100,000/QALY.

<p>The MRI-based strategy is optimal in the blue region, which includes the base-case result (marked by an “X”); the no treatment strategy is optimal in the red region given some other combinations of MRI sensitivity and specificity. The line separating the blue and red regions has an angle <45 degrees, which indicates that the results are more influenced by specificity than sensitivity.</p

Lifetime per-person mRS0-1 outcomes, stroke onset time outcomes, inappropriately treated outcomes, quality-adjusted life years (QALYs), costs (),andincrementalcost−effectivenessratios(), and incremental cost-effectiveness ratios (/QALY) for acute wakeup stroke patients.

<p>Lifetime per-person mRS0-1 outcomes, stroke onset time outcomes, inappropriately treated outcomes, quality-adjusted life years (QALYs), costs ($), and incremental cost-effectiveness ratios ($/QALY) for acute wakeup stroke patients.</p