Real-life costs and effects of an implementation program to increase thrombolysis in stroke
Neurology, 08/08/2012
Clinical Article
Dirks M et al. – A Breakthrough Series implementation program of thrombolysis increases thrombolysis. It saves short– and long–term health care costs due to lower hospital admission and residential costs, increasing stroke care efficiency.
Methods- The practice study includes 12 randomized hospitals and 5,515 patients.
- Its present cost-effectiveness analysis involves 1,657 patients with ischemic stroke admitted within 4 hours from onset.
- Defined primary outcomes are thrombolysis rate and actual health care costs up to 3 months, including additional implementation efforts.
- Secondary outcomes are lifetime quality-adjusted years (QALYs) and lifetime costs of individual trial patients, using a validated probabilistic, disability-stratified stroke life table.
- Differences in outcome include 95% confidence intervals (CI), adjusted for intracluster correlation.
- The thrombolysis rate in the intervention group was 44.3% vs 39.8% in the control group (difference 4.5%; 95% CI 3.1% to 5.9%.
- Mean costs per patient at 3 months (euros were converted to 2010 USD) were $9,192 USD in the intervention group and $9,647 USD in the control group (difference -$455 USD; 95% CI -$232 to -$679 USD).
- Lifetime QALYs in the intervention group were 3.89 and in the control group 3.84 (difference 0.05; 95% CI -0.04 to 0.14).
- The mean lifetime costs in the intervention group were $22,994 USD against $24,315 USD in the control group (difference -$1,321 USD; 95% CI -$1,722 to -$921 USD).
