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Background: Although geographical differences in treatment and outcomes after stroke have been described, we lack evidence on differences in the costs of treatment between urban and nonurban regions. Additionally, it is unclear whether greater costs in one setting are justified given the outcomes achieved. We aimed to compare costs and quality-adjusted life years in people with stroke admitted to urban and nonurban hospitals in New Zealand. Methods: Observational study of patients with stroke admitted to the 28 New Zealand acute stroke hospitals (10 in urban areas) recruited between May and October 2018. Data were collected up to 12 months poststroke including treatments in hospital, inpatient rehabilitation, other health service utilization, aged residential care, productivity, and health-related quality of life. Costs in New Zealand dollars were estimated from a societal perspective and assigned to the initial hospital that patients presented to. Unit prices for 2018 were obtained from government and hospital sources. Multivariable regression analyses were conducted when assessing differences between groups. Results: Of 1510 patients (median age 78 years, 48% female), 607 presented to nonurban and 903 to urban hospitals. Mean hospital costs were greater in urban than nonurban hospitals ($13 191 versus $11 635, P =0.002), as were total costs to 12 months ($22 381 versus $17 217, P P Conclusions: Better outcomes following initial presentation to urban hospitals were associated with greater costs compared to nonurban hospitals. These findings may inform greater targeted expenditure in some nonurban hospitals to improve access to treatment and optimize outcomes.

Background: Endovascular thrombectomy (EVT) access in remote areas is limited. Preliminary data suggest that long distance transfers for EVT may be beneficial; however, the magnitude and best imaging strategy at the referring center remains uncertain. We hypothesized that patients transferred >300 miles would benefit from EVT, achieving rates of functional independence (modified Rankin Scale [mRS] score of 0–2) at 3 months similar to those patients treated at the comprehensive stroke center in the randomized EVT extended window trials and that the selection of patients with computed tomography perfusion (CTP) at the referring site would be associated with ordinal shift toward better outcomes on the mRS. Methods: This is a retrospective analysis of patients transferred from 31 referring hospitals >300 miles (measured by the most direct road distance) to 9 comprehensive stroke centers in Australia and New Zealand for EVT consideration (April 2016 through May 2021). Results: There were 131 patients; the median age was 64 [53–74] years and the median baseline National Institutes of Health Stroke Scale score was 16 [12–22]. At baseline, 79 patients (60.3%) had noncontrast CT+CT angiography, 52 (39.7%) also had CTP. At the comprehensive stroke center, 114 (87%) patients underwent cerebral angiography, and 96 (73.3%) proceeded to EVT. At 3 months, 62 patients (48.4%) had an mRS score of 0 to 2 and 81 (63.3%) mRS score of 0 to 3. CTP selection at the referring site was not associated with better ordinal scores on the mRS at 3 months (mRS median of 2 [1–3] versus 3 [1–6] in the patients selected with noncontrast CT+CT angiography, P =0.1). Nevertheless, patients selected with CTP were less likely to have an mRS score of 5 to 6 (odds ratio 0.03 [0.01–0.19]; P Conclusions: In selected patients transferred >300 miles, there was a benefit for EVT, with outcomes similar to those treated in the comprehensive stroke center in the EVT extended window trials. Remote hospital CTP selection was not associated with ordinal mRS improvement, but was associated with fewer very poor 3-month outcomes.

Introduction: The REGIONS Care project is a New Zealand (NZ) based nationwide project that aims to capture all stroke patients admitted to NZ hospitals exploring ethic and geographic inequities in stroke care access and patient outcomes. Findings from this study will advise the National Stroke Programme strategy. This project includes an organisational survey to assess current availability of interventions and general management approaches in each hospital. Methods: This is a prospective registry based study with up to one year follow-up. Patients are registered into a central database by hospital teams and follow-up is achieved primarily via telephone calls. The outcome data will be adjusted for baseline function and stroke severity among other factors. At this stage the main study is ongoing, but the organisational survey has been completed. Analysis has not yet been finalised. Final and validated results will be presented at the meeting. Results: All NZ hospitals were approached and 100% completed the online survey. Preliminary results found that of these hospitals 82% have an acute stroke unit, 86% have a TIA pathway, but only 57% offer rapid access specialist TIA services. 100% offer thrombolysis, 93% use an EMS pre-notification and rapid ED triage system, and 75% an in-hospital ‘code stroke’ alert. 11% offer onsite thrombectomy, and a further 41% access thrombectomy via rapid inter-hospital transfer. 82% offer inter-disciplinary team review within 24 hours of admission and while 100% have access to OT, PT, and SLT, only 27% have access to a psychologist. 100% offer inpatient and 92% community rehabilitation service while only 11% offer early supported discharge programmes. Only 31% of hospitals have a dedicated stroke rehab unit. While 88% routinely provide stroke patient education, only 52% provide individualised stroke care plans at discharge. Conclusion: These preliminary results show good access to thrombolysis and multi-disciplinary stroke care. However, improvements are needed in access to thrombectomy, rapid specialist TIA services, early supported discharge, dedicated stroke rehabilitation units, psychologists, and individualised patient care plans. Final and additional results will be presented at the conference.