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Thrombolysis, stroke units and other strategies for reducing acute stroke costs
T H Wein1, S L Hickenbottom, A V Alexandrov
1Department of Neurology, University of Texas-Houston Medical School, USA. twein@neuro.med.uth.tmc.edu
Insights
Recombinant tissue plasminogen activator (rt-PA) therapy can significantly reduce stroke treatment costs and improve patient outcomes. Specialized stroke care, including stroke units, further enhances these benefits by decreasing hospital stays and dependency.
Area of Science:
- Neurology
- Health Economics
- Public Health
Background:
- Stroke is a leading cause of disability and mortality in the US, incurring substantial healthcare costs.
- Current stroke treatments, such as intravenous recombinant tissue plasminogen activator (rt-PA), show promise in improving patient outcomes.
- The economic impact of stroke necessitates exploring cost-effective treatment and care strategies.
Purpose of the Study:
- To evaluate the cost-effectiveness of rt-PA therapy for acute ischemic stroke.
- To assess the projected financial savings associated with rt-PA treatment.
- To explore the role of specialized stroke care in improving patient outcomes and reducing healthcare expenditures.
Main Methods:
- Utilized a Markov model to analyze the National Institute of Neurological Disease and Stroke (NINDS) rt-PA Stroke Study data.
- Examined projected savings based on decreased hospital length of stay, rehabilitation, and nursing home costs.
- Reviewed meta-analysis findings on the impact of stroke units and multidisciplinary stroke teams.
Main Results:
- Projected savings of $US4 to $US5 million per 1000 patients treated with rt-PA.
- rt-PA therapy demonstrated improvements in quality-adjusted life-years and increased direct-to-home discharges.
- Stroke units were found to decrease length of hospital stay, mortality, and patient dependency.
Conclusions:
- rt-PA therapy offers significant cost benefits and improves outcomes for eligible ischemic stroke patients.
- Specialized stroke care, including stroke units, can further reduce healthcare costs and enhance patient recovery.
- Expanding access to standardized, specialized stroke care is crucial for maximizing economic and clinical benefits, especially for the majority not eligible for thrombolysis.
Abstract:
Stroke is the leading cause of long term disability and the third leading cause of death in the US. Nearly $US40.9 billion (1997 values) are spent each year on direct and indirect stroke-related costs in the US alone. Length of hospital stay, hospital overheads and nursing-related and rehabilitation costs account for the majority of stroke-related expenditures. Intravenous recombinant tissue plasminogen activator (rt-PA) therapy for patients presenting within 3 hours from onset of ischaemic stroke was shown to improve outcome at 3 months by the National Institute of Neurological Disease and Stroke (NINDS) investigators using a dosage of 0.9 mg/kg. When the NINDS rt-PA Stroke Study results were examined using a Markov model, savings of $US4 to $US5 million (1996 values) per 1000 patients treated with rt-PA were projected. These savings were predicted to result from decreases in length of hospital stay, inpatient rehabilitation and nursing home costs, increases in the number of patients discharged directly to home and improvements in quality-adjusted life-years. Furthermore, a recent meta-analysis has documented that the institution of stroke units, consisting of multidisciplinary specialised stroke teams, also decreased length of hospital stay, death and dependency. Because only a minority of patients who have a stroke are currently eligible for thrombolysis, implementation of specialised and standardised stroke care may further enhance cost benefits and improve patient outcomes.