Cost-effectiveness of optimizing acute stroke care services for thrombolysis.

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Penaloza-Ramos, Maria Cristina 
Sheppard, James P 
Jowett, Sue 
Barton, Pelham 

BACKGROUND AND PURPOSE: Thrombolysis in acute stroke is effective up to 4.5 hours after symptom onset but relies on early recognition, prompt arrival in hospital, and timely brain scanning. This study aimed to establish the cost-effectiveness of increasing thrombolysis rates through a series of hypothetical change strategies designed to optimize the acute care pathway for stroke. METHODS: A decision-tree model was constructed, which relates the acute management of patients with suspected stroke from symptom onset to outcome. Current practice was modeled and compared with 7 change strategies designed to facilitate wider eligibility for thrombolysis. The model basecase consisted of data from consenting patients following the acute stroke pathway recruited in participating hospitals with data on effectiveness of treatment and costs from published sources. RESULTS: All change strategies were cost saving while increasing quality-adjusted life years gained. Using realistic estimates of effectiveness, the change strategy with the largest potential benefit was that of better recording of onset time, which resulted in 3.3 additional quality-adjusted life years and a cost saving of US $46,000 per 100,000 population. All strategies increased the number of thrombolysed patients and the number requiring urgent brain imaging (by 9% to 21% dependent on the scenario). Assuming a willingness-to-pay of US $30,000 per quality-adjusted life year gained, the potential budget available to deliver the interventions in each strategy ranged from US $50,000 to US $144,000. CONCLUSIONS: These results suggest that any strategy that increases thrombolysis rates will result in cost savings and improved patient quality of life. Healthcare commissioners could consider this model when planning improvements in stroke care.

quality-adjusted life years, technology assessment, tissue plasminogen activator, Aged, Aged, 80 and over, Budgets, Cost-Benefit Analysis, Costs and Cost Analysis, Decision Trees, Female, Health Resources, Humans, Male, Middle Aged, Models, Economic, Outcome and Process Assessment, Health Care, Patient Care Management, Population, Quality Improvement, Quality-Adjusted Life Years, Stroke, Thrombolytic Therapy, United States
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Ovid Technologies (Wolters Kluwer Health)
This work was supported by the National Institute for Health Research (NIHR) as part of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) programme for Birmingham and Black Country. R.J. McManus held a Career Development Fellowship during the study and now holds an NIHR Professorship. The views and opinions expressed are those of the authors and do not necessarily reflect those of the National Health Service, NIHR, or the Department of Health.