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J Am Heart Assoc. 2017 May 8;6(5). pii: e004513. doi: 10.1161/JAHA.116.004513.

Observed Cost and Variations in Short Term Cost-Effectiveness of Therapy for Ischemic Stroke in Interventional Management of Stroke (IMS) III.

Author information

1
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC simpsonk@musc.edu.
2
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC.
3
Department of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC.
4
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC.
5
Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OH.
6
Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
7
Division of Emergency Medicine, Medical University of South Carolina, Charleston, SC.
8
Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PA.
9
Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
10
Institute of Diagnostic and Interventional Neuroradiology, University Hospital Dresden, Dresden, Germany.
11
Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
12
Department of Neurology, University Medical Center Utrecht and the Rudolph Magnus Institute of Neurosciences, Utrecht, The Netherlands.
13
St. Antonius Hospital, Nieuwegein, The Netherlands.
14
Department of Neurology and Stroke Center, Lariboisière Hospital, DHU NeuroVasc, Paris, France.
15
Neurorehabilitation Unit, Department of Neurology, Basel University Hospital, University of Basel, Basel, Switzerland.
16
University Center for Medicine of Aging, Felix Platter Hospital, Basel, Switzerland.
17
George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia.
18
National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD.

Abstract

BACKGROUND:

Examination of linked data on patient outcomes and cost of care may help identify areas where stroke care can be improved. We report on the association between variations in stroke severity, patient outcomes, cost, and treatment patterns observed over the acute hospital stay and through the 12-month follow-up for subjects receiving endovascular therapy compared to intravenous tissue plasminogen activator alone in the IMS (Interventional Management of Stroke) III Trial.

METHODS AND RESULTS:

Prospective data collected for a prespecified economic analysis of the trial were used. Data included hospital billing records for the initial stroke admission and subsequent detailed resource use after the acute hospitalization collected at 3, 6, 9, and 12 months. Cost of follow-up care varied 6-fold for patients in the lowest (0-1) and highest (20+) National Institutes of Health Stroke Scale category at 5 days, and by modified Rankin Scale at 3 months. The kind of resources used postdischarge also varied between treatment groups. Incremental short-term cost-effectiveness ratios varied greatly when treatments were compared for patient subgroups. Patient subgroups predefined by stroke severity had incremental cost-effectiveness ratios of $97 303/quality-adjusted life year (severe stroke) and $3 187 805/quality-adjusted life year (moderately severe stroke).

CONCLUSIONS:

Detailed economic and resource utilization data from IMS III provide powerful evidence for the large effect that patient outcome has on the economic value of medical and endovascular reperfusion therapies. These data can be used to inform process improvements for stroke care and to estimate the cost-effectiveness of endovascular therapy in the US health system for stroke intervention trials.

CLINICAL TRIAL REGISTRATION:

URL: http://www.clinicaltrials.gov. Registration number: NCT00359424.

KEYWORDS:

cost; cost‐effectiveness; ischemic; stroke; stroke care; tissue‐type plasminogen activator

PMID:
28483774
PMCID:
PMC5524059
DOI:
10.1161/JAHA.116.004513
[Indexed for MEDLINE]
Free PMC Article

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