Any strategy that raised thrombolysis rates, including increased use of imaging, ultimately would pay for itself through cost savings and improved quality of life for stroke patients, an analysis published online Jan. 2 in Stroke concluded.
The Birmingham and Black Country Collaborations for Leadership in Applied Health Research and Care investigators in the U.K. conducted the study to evaluate the cost-effectiveness of strategies designed to increase thrombolysis rates in patients with acute stroke. The authors, led by Maria Christina Penaloza-Ramos, MA, of the University of Birmingham, recognized that most cost-effectiveness studies compared the use of thrombolysis with no thrombolysis.
“Although these studies found thrombolytic therapy to be cost-effective, they are of less relevance, and now such treatment is established routine clinical practice,” they wrote.
The authors created a decision-tree model that compared current practice with seven other strategies. Costs included initial assessment, treatment and long-term care from stroke-related disabilities in 2012 dollars. They used data from two hospitals and one ambulance service involving patients admitted between 2010 and 2011 to populate the model.
Based on 488 stroke events, they calculated that 9 percent of patients received thrombolysis. Current practice yielded 2,251 quality-adjusted life-years (QALYs) per 100,000 population at a cost of $20,813,510.
A strategy of having patients receive a CT scan immediately on arrival provided the greatest cost savings, reducing costs by $74,890 with 5.4 additional QALYs per 100,000 population. The as-yet theoretical strategy of using new imaging techniques to estimate onset time for wakeup strokes offered $52,863 in cost savings with 3.8 additional QALYs per 100,000 population.
The strategy that emerged as the best performing and best achievable—improving recognition and recording of onset time—lowered cost by $46,000 with 3.3 additional QALYs per 100,000 population.
The model showed that any strategy that increased thrombolysis rates was cost-effective and that the savings soon would cover the cost of implementation. “We found that up to US $144,000 per 100,000 population could be invested in an intervention that improves recognition and recording of onset time among healthcare professionals, and the intervention would still be cost-effective at a willingness-to-pay of US $30,000 per QALY gained,” they wrote.
The model used a 4.5-hour time frame for thrombolysis administration, a period considered safe and effective for acute stroke treatment. “In reality, improvements in the timeliness of care may lead to incrementally better outcome, and therefore it is possible that even greater benefit could be achieved from a given change strategy,” they added.