Abstract 3030: Meta-analysis of Cost Effectiveness of Different Stroke Unit Subtypes

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Minal Jain ◽  
Anunaya Jain ◽  
Abhijit R Kanthala ◽  
Babak S Jahromi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Systems Of Care ◽  
Surrogate Marker ◽  
Cost Effective ◽  
Stroke Care ◽  
Developed Countries ◽  
Direct Care ◽  
Early Supported Discharge ◽  
Acute Rehabilitation

Aim: To perform a systematic review and metanalysis, comparing outcome and cost of stroke care in a stroke unit (SU) versus conventional care (CC). Secondary aim was to compare cost effectiveness of different SU subtypes. Methods: Pubmed search was performed for “Stroke Unit” among all English language articles from 01/01/1996 to 01/01/2011. Only articles from developed countries, reporting the length of stay (LOS) and/or cost and outcomes for ischemic stroke were included. Studies wherein data was collected before 01/01/1996, articles only on rehabilitation units, and all systematic reviews were excluded. LOS was taken as a surrogate marker of stroke care cost in studies wherein direct care costs were not reported. Non-QALY outcomes were converted to QALYs using reported logistic regressions. Ratios less than $50,000/QALY were considered cost effective while greater than $100,000 /QALY were considered non-cost effective. All cost were reported in 2010 US$. Result: A total of 5,537 articles in Pubmed were studied, of which 19 studies met the inclusion criteria. LOS for patients managed at SU ranged from 9.2-32.3 days versus 8-35.3 days for CC units and average incremental QALYs between them were 0.09. The average incremental cost/QALY was $41,204.37. The average cost/QALY for different types of SU were $19,428.64 for Acute only SU (A SU), $44,228.81 for Acute+Rehabilitation SU (A+R SU), $29,145.93 for Acute+Rehabilitation+Early Supported Discharge (A+R+ESD) SU and $20,460.56 for SU with Continuous monitoring (SU CM). In comparison to an A SU, SU CM and A+R+ESD SU were cost effective alternatives (ICER SU CM estimated at $25,120.89, ICER A+R+ESD SU estimated at $24,574.59). Conclusion: Stroke Units are cost effective when compared to the conventional systems of care. Acute + rehab SU with early supported discharge appears to be the most cost effective model amongst different subtypes of SU.

Stroke Care Services in Africa: A Systematic Review

2018 ◽  
Vol 1 (1) ◽  
pp. 55-64 ◽  
Author(s):  
Rufus O. Akinyemi ◽  
Olaleye A. Adeniji
Keyword(s):  
Large Scale ◽  
Systems Of Care ◽  
Care Delivery ◽  
Stroke Care ◽  
Developed Countries ◽  
High Morbidity ◽  
New Paradigm ◽  
African Countries ◽  
Care Services ◽  
Stroke Services

Background: Stroke is the second leading cause of death and adult-onset disability globally. Although its incidence is reducing in developed countries, low- and middle-income countries, especially African countries, are witnessing an increase in cases of stroke, leading to high morbidity and mortality. Evidently, a new paradigm is needed on the continent to tackle this growing burden of stroke in its preventative and treatment aspects. Aims and Objectives: The aim of this study was to determine the scope of stroke care services, where they exist, and their relationship with currently existing health systems. Methods: A detailed literature search was undertaken referring to PubMed and Google Scholar for articles from January 1960 to March 2018, using a range of search terms. Of 93 publications, 45 papers were shortlisted, and 21 reviewed articles on existing stroke services were included. Results: The literature on models of stroke services in Africa is sparse. We identified focused systems of care delivery in the hyperacute, acute, and rehabilitative phases of stroke in a few African countries. There is a continent-wide paucity of data on the organization of prehospital stroke services. Only 3 African countries (South Africa, Egypt, and Morocco) reported experiences on thrombolysis. Also, the uptake of dedicated stroke units appears limited across the continent. Encouragingly, there are large-scale secondary prevention models on the continent, mostly within the context of experimental research projects, albeit with promising results. We found only 1 article on the interventional aspects of stroke care in our review, and this was a single-center report. Conclusions: The literature on the organization of stroke services is sparse in Africa. Dedicated action at policy, population, community, and hospital-based levels is urgently needed toward the organization of stroke services to tame the burgeoning burden of stroke on the African continent.

scholarly journals Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: an observational cohort study in the Northern Territory of Australia

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e015033 ◽  
Author(s):  
Yuejen Zhao ◽  
Steven Guthridge ◽  
Henrik Falhammar ◽  
Howard Flavell ◽  
Dominique A Cadilhac
Keyword(s):  
Cost Effectiveness ◽  
Incremental Cost ◽  
Policy Development ◽  
Cost Effective ◽  
Haemorrhagic Stroke ◽  
Stroke Care ◽  
Northern Territory ◽  
Public Hospitals ◽  
Hospital Inpatient ◽  
Aboriginal Population

ObjectiveTo assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia.DesignCost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents.SettingPublic hospitals in the NT from 1992 to 2013.ParticipantsIndividual patient data were extracted and linked from the hospital inpatient and primary care information systems.Outcome measuresIncremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding.Results2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25).ConclusionsStroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.

A COMPARISON OF THE COST-EFFECTIVENESS OF STROKE CARE PROVIDED IN LONDON AND COPENHAGEN

2000 ◽  
Vol 16 (2) ◽  
pp. 684-695 ◽  
Author(s):  
Richard Grieve ◽  
Vibeke Porsdal ◽  
John Hutton ◽  
Charles Wolfe
Keyword(s):  
Cost Effectiveness ◽  
Purchasing Power Parity ◽  
Average Length ◽  
Cost Effective ◽  
Stroke Care ◽  
Community Health Services ◽  
Case Mix ◽  
Power Parity ◽  
Model Of Care ◽  
London Model

Objectives: This study compared the relative cost-effectiveness of stroke care provided in London and Copenhagen.Methods: Hospitalized stroke patients at centers in London (1995–96) and Copenhagen (1994–95) were included. Each patient's use of hospital and community health services was recorded for 1 year after stroke. Center-specific unit costs were collected and converted into dollars using the Purchasing Power Parity Index. An incremental cost-effectiveness ratio (ICER) was calculated comparing a Copenhagen model of stroke care to a London model, using regression analysis to adjust for case-mix differences.Results: A total of 625 patients (297 in Copenhagen, 328 in London) were included in the analysis. Most patients in London (85%) wereadmitted to general medical wards, with 26% subsequently transferred to a stroke unit. In Copenhagen, 57% of patients were directly admitted to a stroke or neurology unit, with 23% then transferred to a separate rehabilitation hospital. The average length of total hospital stay was 11 days longer in Copenhagen. Patients in Copenhagen were less likely to die than those in London; for patients with cerebral infarction the hazard ratio after case-mix adjustment was 0.53 (95% CI from 0.35 to 0.80). However, a lower proportion of patients with hemorrhagic stroke died in London. The ICER of using the Copenhagen compared with the London model of care ranged from $21,579 to $37,444 per life-year gained for patients with cerebral infarctions.Conclusions: The ICERs of the Copenhagen compared with the London model of care were within a range generally regarded as cost-effective.

scholarly journals Evaluating the Cost-effectiveness Analysis of Rehabilitation Methods for Patients with Stroke

2021 ◽  
Author(s):  
Farzaneh Miri ◽  
Nader Jahanmehr ◽  
Reza Goudarzi
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Cost Effective ◽  
Cost Effectiveness Analysis ◽  
Sensitivity Analyses ◽  
Rehabilitation Service ◽  
Effectiveness Analysis ◽  
The Cost ◽  
Rehabilitation Strategy ◽  
At Home

Abstract Aims: This study evaluated and compared the cost-effectiveness of rehabilitation interventions in patients with stroke in the three alternatives of hospitals, units and homes due to the fact that one of the stroke management challenges is how to provide a rehabilitation service to these patients in Iran. Methods: This is a cost-effectiveness analysis from the perspective of a health system. A Markov model with a 20-year time horizon in 3-month cycles was used to analyze the costs and outcomes. Cost data were collected from the 210 patients undergoing rehabilitation in the hospital, home and unit. Utility data were extracted from previously published literature with the same setting. The cost-effectiveness analysis was conducted by calculating ICER using TreeAge Software. Basic and probabilistic sensitivity analyses were also conducted at the end. Results: The average cost of rehabilitation in home strategy ($ 2306) was less than hospital ($2955) and unit ($3485) strategies. Furthermore, the utility of home strategy (26.03) was 8 units higher than hospital utility (17.99) and 19 units higher than utility of the stroke unit (7.03). The Acer values of hospital, stroke unit and home groups were $11424, $33159 and $7233 per utility, respectively. According to the results, the home-based rehabilitation strategy is cost effective compared to hospital and unit rehabilitation strategy. The results of the probabilistic sensitivity analysis also showed that the ICER of home strategy is always cost-effective than the other strategies. Limitation: : limitation of the present study was the reliance on utility values of other studies. Conclusion: Rehabilitation at home is the most cost-effective strategy for stroke patients. Given the high rates of this disease in Iran and the high cost of it, it is suggested that policy makers lay the groundwork for providing these services at home.

scholarly journals Cost-Effectiveness of Stroke Unit Care Followed by Early Supported Discharge

Stroke ◽  
2009 ◽  
Vol 40 (1) ◽  
pp. 24-29 ◽  
Author(s):  
Ömer Saka ◽  
Victoria Serra ◽  
Yevgeniy Samyshkin ◽  
Alistair McGuire ◽  
Charles C.D.A. Wolfe
Keyword(s):  
Cost Effectiveness ◽  
Stroke Unit ◽  
Early Supported Discharge ◽  
Stroke Unit Care

Health impact and economic analysis of NGO-supported neurosurgery in Bolivia

2014 ◽  
Vol 20 (4) ◽  
pp. 436-442 ◽  
Author(s):  
Jared D. Ament ◽  
Kevin R. Greene ◽  
Ivan Flores ◽  
Fernando Capobianco ◽  
Gueider Salas ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Spinal Instrumentation ◽  
Cost Effective ◽  
Health Impact ◽  
Quality Adjusted Life Year ◽  
Cost Utility ◽  
Direct Care ◽  
Health Concern ◽  
Discounted Cost

Object Bolivia, one of the poorest countries in the world, ranks 108th on the 2013 Human Development Index. With approximately 1 neurosurgeon per 200,000 people, access to neurosurgery in Bolivia is a growing health concern. Furthermore, neurosurgery in nonindustrialized countries has been considered both cost-prohibitive and lacking in outcomes evaluation. A non-governmental organization (NGO) supports spinal procedures in Bolivia (Solidarity Bridge), and the authors sought to determine its impact and cost-effectiveness. Methods In a retrospective review of prospectively collected data, 19 patients were identified prior to spinal instrumentation and followed over 12 months. For inclusion, patients required interviewing prior to surgery and during at least 2 follow-up visits. All causes of spinal pathology were included. Sixteen patients met inclusion criteria and were therefore part of the analysis. Outcomes measured included assessment of activities of daily living, pain, ambulation, return to work/school, and satisfaction. Cost-effectiveness was determined by cost-utility analysis. Utilities were derived using the Health Utilities Index. Complications were incorporated into an expected value decision tree. Results Median (± SD) preoperative satisfaction was 2.0 ± 0.3 (on a scale of 0–10), while 6-month postoperative satisfaction was 7 ± 1.4 (p < 0.0001). Ambulation, pain, and emotional disability data suggested marked improvement (56%, 69%, and 63%, respectively; p = 0.035, 0.003, and 0.006). Total discounted incremental quality-adjusted life year (QALY) gain was 0.771. The total discounted cost equaled $9036 (95% CI $8561–$10,740) at 2 years. Computing the incremental cost-effectiveness ratio resulted in a value of $11,720/QALY, ranging from $9220 to $15,473/QALY in a univariate sensitivity analysis. Conclusions This NGO-supported spinal instrumentation program in Bolivia appears to be cost-effective, especially when compared with the conventional $50,000/QALY benchmark and the WHO endorsed country-specific threshold of $16,026/QALY. However, with a gross domestic product per capita in Bolivia equaling $4800 per year and 30.3% of the population living on less than $2 per day, this cost continues to appear unrealistic. Additionally, the study has several significant limitations, namely its limited sample size, follow-up period, the assumption that patients not receiving surgical intervention would not make any clinical improvement, the reliance on the NGO for patient selection and sustainable practices such as follow-up care and ancillary services, and the lack of a randomized prospective design. These limitations, as well as an unclear understanding of Bolivian willingness-to-pay data, affect the generalizability of the study findings and impede widespread economic policy reform. Because cost-effectiveness research may inevitably direct care decisions and prove that an effort such as this can be cost saving, a prospective, properly controlled investigation is now warranted.

scholarly journals Combined Clinical and Home Rehabilitation: Case Report of an Integrated Knowledge-to-Action Study in a Dutch Rehabilitation Stroke Unit

2015 ◽  
Vol 95 (4) ◽  
pp. 558-567 ◽  
Author(s):  
Christa S. Nanninga ◽  
Klaas Postema ◽  
Marleen C. Schönherr ◽  
Sacha van Twillert ◽  
Ant T. Lettinga
Keyword(s):  
Case Report ◽  
Stroke Unit ◽  
Practical Knowledge ◽  
Transfer Problem ◽  
Stroke Care ◽  
Application Process ◽  
Research Knowledge ◽  
Knowledge To Action ◽  
Straightforward Application ◽  
Early Supported Discharge

Background and Purpose There is growing awareness that the poor uptake of evidence in health care is not a knowledge-transfer problem but rather one of knowledge production. This issue calls for re-examination of the evidence produced and assumptions that underpin existing knowledge-to-action (KTA) activities. Accordingly, it has been advocated that KTA studies should treat research knowledge and local practical knowledge with analytical impartiality. The purpose of this case report is to illustrate the complexities in an evidence-informed improvement process of organized stroke care in a local rehabilitation setting. Case Description A participatory action approach was used to co-create knowledge and engage local therapists in a 2-way knowledge translation and multidirectional learning process. Evidence regarding rehabilitation stroke units was applied in a straightforward manner, as the setting met the criteria articulated in stroke unit reviews. Evidence on early supported discharge (ESD) could not be directly applied because of differences in target group and implementation environment between the local and reviewed settings. Early supported discharge was tailored to the needs of patients severely affected by stroke admitted to the local rehabilitation stroke unit by combining clinical and home rehabilitation (CCHR). Outcomes Local therapists welcomed CCHR because it helped them make their task-specific training truly context specific. Key barriers to implementation were travel time, logistical problems, partitioning walls between financing streams, and legislative procedures. Discussion Improving local settings with available evidence is not a straightforward application process but rather a matter of searching, logical reasoning, and creatively working with heterogeneous knowledge sources in partnership with different stakeholders. Multiple organizational levels need to be addressed rather than focusing on therapists as sole site of change.

A review of early supported discharge after stroke

2010 ◽  
Vol 20 (4) ◽  
pp. 327-337 ◽  
Author(s):  
Linda Brewer ◽  
David Williams
Keyword(s):  
Cost Effectiveness ◽  
Discharge Planning ◽  
Stroke Care ◽  
International Studies ◽  
Acute Stroke Care ◽  
Rehabilitation Team ◽  
Early Supported Discharge ◽  
Essential Components ◽  
Bed Days ◽  
The Cost

SummaryStroke is a leading cause of disability worldwide and patients with stroke frequently require prolonged periods of in-patient rehabilitation prior to discharge. This poses a large economic strain on health services, and the cost-effectiveness of this system has been questioned. However, in implementing changes in the delivery of post-acute stroke care it is important that patient outcome is not compromised. Early supported discharge (ESD) was introduced approximately 15 years ago and allows suitable patients to be discharged home early with increased support from a well co-ordinated, multi-disciplinary rehabilitation team in the patient's own home. This paper focuses upon the evidence available from multiple international studies of ESD over the last decade, including both clinical benefit and cost-effectiveness. Findings from these trials are largely positive resulting from a reduction in bed days, therefore overall cost, and an improvement in function and independence reported in many studies. Suitable patient selection, careful discharge planning and continuity of care by the ESD linked to a stroke unit are essential components of the success of this service.

P6142LATIN telemedicine - expanded umbrella of cost-effective ami coverage for 100 million people

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Torres ◽  
S Mehta ◽  
R Botelho ◽  
F Fernandez ◽  
J Cade ◽  
...  
Keyword(s):  
Systems Of Care ◽  
Cost Effective ◽  
Developed Countries ◽  
Population Based ◽  
Primary Pci ◽  
Hub And Spoke ◽  
Web Based ◽  
Catheterization Laboratory ◽  
Number Of Patients ◽  
And Training

Abstract Background AMI is a unique entity where the immediate diagnosis can be made by a single test, the EKG. Despite this matchless attribute of easy diagnosis, developing (and some developed) countries lack resources and efficient pathways for urgent and reliable diagnosis of AMI. With Latin Telemedicine Infarct Network (LATIN), we have previously presented Telemedicine as a pragmatic solution for urgent and accurate diagnosis of AMI. In this work, we reveal pathways of scalable population-based AMI management models. Purpose To utilize telemedicine as a foundation pillar for creating cost-effective and global models of AMI management. Methods LATIN pilot tested the hypothesis of remote guidance of AMI management and expanded access by creating a hub and spoke, STEMI systems of care that exploited regional resources. A highly efficient, web-based, cloud-computing prototype was developed and scrupulously monitored with a new metric of time to telemedicine diagnosis (TTD). STEMI systems of care were created to efficiently triage the diagnosed patients for being treated with thrombolysis, pharmaco-invasive management or Primary PCI. This stratagem had enormous provincial variability and was constrained mainly by ambulance structure. Telemedicine and IT costs were forced lower and enabled a cost-effective process to hugely provide access to 100 million patients located in poorer regions of Colombia, Brazil, Mexico, and Argentina. Education and training have formed the mantra for LATIN and stakeholder development, and ambulance systems development has remained immutable goals. Results Almost 800,000 patients were successfully screening through LATIN with a cost for accurate STEMI diagnosis of < $3, a tele accuracy that exceeded 95% and with TTD <4 minutes. A total of 8,440 (1.1%) of patients were diagnosed with AMI in this manner and 3,924 (46.5%) urgently reperfused, mainly with Primary PCI (3,048, 77.8%). D2B times have been lowered now to 51 minutes but this is fortuitous, as several PCI-capable facilities are small, and direct transfer to the catheterization laboratory is easy. Door in and Door out times and transport times remain high as a large number of patients are denied by insurance and other payers for treatment. Overall, mortality is 5.2%. Conclusions Global financial and philanthropic institutions should contemplate models analogous to LATIN for saving the lives of millions of poor patients in developing countries from AMI.

scholarly journals Cost-Effectiveness of a Multifaceted Quality Improvement Intervention for Acute Ischemic Stroke in China

Stroke ◽  
2020 ◽  
Vol 51 (4) ◽  
pp. 1265-1271 ◽  
Author(s):  
Yuesong Pan ◽  
Lei Zhang ◽  
Zixiao Li ◽  
Xia Meng ◽  
Yilong Wang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Stroke Care ◽  
Quality Improvement Intervention ◽  
Life Years ◽  
Chinese Yuan ◽  
Quality Adjusted Life ◽  
Improvement Intervention

Background and Purpose— Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world’s largest low- and middle-income country. Methods— A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings. Results— Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1× gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year. Conclusions— A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.

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