Cost analysis may support ICU transfers for intracranial bleeding

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When it comes to long-term cost in transferring patients to specialized neurological intensive care units (ICUs) following an intracerebral hemorrhage, patient outcomes play a significant role.

Using a nationwide inpatient sample and previous cost-effectiveness models for stroke, a research team looked at lifetime costs for patients with intracerebral hemorrhage, provided they were transported to the nearest neurological ICU available after originally presenting to hospitals without neurologically specialized ICUs.

Jeffrey J. Fletcher, MD, MSc, from the department of neurosurgery at the University of Michigan in Ann Arbor, and colleagues analyzed cost against functional outcomes. Outcomes, such as mortality and functionality, were assessed and stratified using a modified Rankin Scale (mRS), with the best outcomes having the lowest mRS scores and the worst having the highest. These were then grouped into most favorable (mRS: 1-2), moderately favorable (mRS: 3-4) and least favorable (mRS: 5). Costs were estimated at 90 days after the hemorrhage and at annually for lifetime calculations.

Lifetime horizon costs incurred by patients with the most favorable outcomes came down to $47,431 per quality-adjusted life years (QALY), compared to patients who were not transferred. Moderately favorable outcomes cost $91,674 per QALY and least favorable cost $380,358 per QALY. Fletcher et al noted that, assuming a willingness to pay of $100,000 per year, favorable and moderately favorable outcomes were cost-effective. However, at a reduced estimate of willingness to pay around $50,000, only the most favorable outcomes were considered cost-effective.

“Although our findings highlight that the cost-effectiveness of transferring ICH [intracerebral hemorrhage] patients to centers with neuro-ICUs depends heavily on the distribution of functional outcome in survivors, whether a specific cost-effectiveness threshold should be used in medical care is debated,”  they wrote. They noted that lifetime costs may include a large range of lifesaving technologies and practices, some more cost-effective and beneficial than others.

Fletcher et al wrote, “If neuro-ICUs improve survival and functional outcome with an acceptable  cost per QALY, then the development of specialized neuro-ICUs should be encouraged at comprehensive stroke centers, as well as routing of patients with ICH to these centers regardless of where they enter the healthcare system.

This study was published online Dec. 4 in Stroke.