Acute Stroke: Cost Effectiveness of Thrombolysis Therapy

Dr. James Sheppard MRC Research Fellow Department of Primary Care Health Sciences University of Interview with
Dr. James Sheppard
MRC Research Fellow
Department of Primary Care Health Sciences
University of Oxford What are the main findings of the study?

Dr. Sheppard: The aim of our study was to develop a decision-tree model which estimates the cost-effectiveness and potential implementation costs of a series of interventions which increase thrombolysis rates in acute stroke. The model examined all possible acute stroke patient pathways and was based on real life patient data. We found all proposed interventions to be cost saving whilst increasing patient quality of life after stroke. We estimate that, assuming a “willingness-to-pay”  of USD $30,000 per quality adjusted life year gained, the potential budget available to deliver interventions which improve acute stroke care range from USD $50,000 to USD $144,000. Were any of the findings unexpected?

Dr. Sheppard: All intervention strategies which increase thrombolysis rates in acute stroke are likely to be cost-effective due to a reduction in dependency after stroke and the subsequent reduction in long term care costs. However, degree of cost savings may be surprising, particularly given the simple nature of some of the interventions modeled. In clinical practice, the level to which a given intervention can improve stroke services will vary between individual stroke centres. Our study suggests that a combination of incremental improvements in multiple parts of the stroke pathway is likely to be the most appropriate, concentrating initially on measures in the early phases of the pathway where the most individuals have most to gain from service improvement. What should clinicians and patients take away from your report?

Dr. Sheppard: All interventions which increase thrombolysis rates are likely to the cost saving and improve patient outcomes. However, clinicians should consider the capacity of local stroke services before implementing change, due to the knock-on effects of increasing thrombolysis rates. In circumstances where existing services are already stretched to capacity, implementation of change may not be straightforward. In addition, it is important to consider that in some instances, initial investment by one healthcare organization may not be recouped until further down the stroke pathway when the patient is under the care of a different healthcare provider. Thus healthcare commissioners should consider funding and resources for stroke care throughout the care continuum. What recommendations do you have for future research as a result of this study?

Dr. Sheppard: The results of this study could be used to guide commissioners and senior healthcare professionals in quality improvement strategies to improve thrombolysis rates such as those assessed here. Future studies should focus on evaluating these strategies as they are implemented into routine clinical practice to ensure such benefits occur, and to evaluate this approach to care planning in other acute clinical settings.


Cost-Effectiveness of Optimizing Acute Stroke Care Services for Thrombolysis

Maria Cristina Penaloza-Ramos, James P. Sheppard, Sue Jowett, Pelham Barton, Jonathan Mant, Tom Quinn, Ruth M. Mellor, Don Sims, David Sandler, and Richard J. McManus

Stroke. 2014;STROKEAHA.113.003216published online before print January 2 2014, doi:10.1161/STROKEAHA.113.003216

Last Updated on February 18, 2014 by Marie Benz MD FAAD