Cost-effectiveness of optimizing acute stroke care services for thrombolysis

Area of Science:

• Health Economics
• Neurology
• Public Health

Background:

• Thrombolysis is a time-sensitive treatment for acute stroke, effective within 4.5 hours of symptom onset.
• Early recognition, hospital arrival, and brain scanning are critical for successful thrombolysis.
• Current acute stroke care pathways present opportunities for optimization to increase thrombolysis rates.

Purpose of the Study:

• To evaluate the cost-effectiveness of various strategies aimed at increasing thrombolysis rates in acute stroke.
• To model hypothetical changes in the acute care pathway to identify optimal interventions.

Main Methods:

• A decision-tree model was developed to simulate the acute management of suspected stroke patients.
• The model compared current practices with seven distinct change strategies.
• Data on treatment effectiveness and costs were sourced from published literature and participating hospitals.

Main Results:

• All evaluated change strategies demonstrated cost savings and increased quality-adjusted life years (QALYs).
• Better recording of symptom onset time yielded the greatest benefit: 3.3 additional QALYs and $46,000 cost savings per 100,000 population.
• Strategies increased thrombolysed patients by 9-21% and urgent brain imaging by 9-21%.

Conclusions:

• Increasing thrombolysis rates in acute stroke is associated with both cost savings and improved patient quality of life.
• Healthcare commissioners can utilize this cost-effectiveness model for strategic planning of stroke care improvements.