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What is the best imaging strategy for acute stroke?
J M Wardlaw1, S L Keir, J Seymour
1Department of Clinical Neurosciences, Western General Hospital (University of Edinburgh), Edinburgh, UK.
Health Technology Assessment (Winchester, England)
|January 21, 2004
Summary
Immediate computed tomographic (CT) scanning for acute stroke is cost-effective, reducing costs and improving quality-adjusted life years (QALYs). Early CT imaging provides crucial diagnostic information, optimizing treatment and patient outcomes.
Area of Science:
- Neurology
- Health Economics
- Medical Imaging
Background:
- Acute stroke diagnosis and management require timely and accurate brain imaging.
- Computed Tomographic (CT) scanning plays a crucial role in differentiating stroke types and guiding treatment.
- The cost-effectiveness of various CT imaging strategies in acute stroke remains an important policy consideration.
Purpose of the Study:
- To determine the cost-effectiveness of computed tomographic (CT) scanning in acute stroke patients.
- To assess the contribution of brain imaging to stroke diagnosis and management.
- To estimate costs, benefits, and risks of different imaging strategies to inform national and local policy.
Main Methods:
- A decision-analysis model was developed to compare 12 alternative CT scan strategies against a 'scan all patients within 48 hours' comparator.
- The study included patients admitted to hospitals in Scotland with a first stroke or managed as outpatients.
- Analysis considered effects on functional outcome, length of stay, quality-adjusted life years (QALYs), and costs associated with different scanning strategies.
Main Results:
- CT scanning is highly sensitive and specific for haemorrhage within the first 8 days of stroke.
- The most cost-effective strategy identified was 'scan all immediately', achieving the most QALYs at the lowest cost compared to other strategies.
- Access to CT scanning, particularly out-of-hours and for outpatients, was variable across Scotland.
Conclusions:
- Immediate CT scanning strategies are generally the most cost-effective, yielding the highest QALYs and lowest costs due to reduced inpatient care expenses.
- Optimizing patient survival and functional independence through early, appropriate management (e.g., aspirin use) significantly reduces costs and increases QALYs.
- The findings support immediate CT scanning as a policy for acute stroke management to improve both clinical outcomes and economic efficiency.