The Cost of Pediatric Stroke Care and Rehabilitation

Endovascular thrombectomy has played a major role in advancing adult stroke care and may serve a similar role in pediatric stroke care. However, there is a need to develop better evidence and infrastructure for pediatric stroke care. In this work, we review 2 experienced pediatric endovascular thrombectomy programs and examine key design features in both care environments, including a formalized protocol and workflow, integration with an adult endovascular thrombectomy workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke.

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MO2 The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

Value in Health ◽

10.1016/j.jval.2012.03.1379 ◽

2012 ◽

Vol 15 (4) ◽

pp. A8

Author(s):

G.F. Guzauskas ◽

D.M. Boudreau ◽

K.F. Villa ◽

S.R. Levine ◽

D.L. Veenstra

Keyword(s):

Cost Effectiveness ◽

Acute Stroke ◽

Stroke Care ◽

Acute Stroke Care ◽

The Cost

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“Strokenomics”: bending the cost curve in stroke care

Journal of Neurosurgery ◽

10.3171/2019.11.jns191960 ◽

2020 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Stephan A. Munich ◽

Kunal Vakharia ◽

Matthew J. McPheeters ◽

Michael K. Tso ◽

Adnan H. Siddiqui ◽

...

Keyword(s):

Medical Therapy ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Cost Savings ◽

Cost Benefit ◽

Stroke Care ◽

Cost Curve ◽

The Cost ◽

Care Costs

OBJECTIVEThe mortality rates for stroke are decreasing, yet it remains a leading cause of disability and the principal neurological diagnosis in patients discharged to nursing homes. The societal and economic burdens of stroke are substantial, with the total annual health care costs of stroke expected to reach $240.7 billion by 2030. Mechanical thrombectomy has been shown to improve functional outcomes compared to medical therapy alone. Despite an incremental cost of $10,840 compared to medical therapy, the improvement in functional outcomes and decreased disability have contributed to the cost-effectiveness of the procedure. In this study the authors describe a physician-led device bundle purchase program implemented for the delivery of stroke care.METHODSThe authors retrospectively reviewed the clinical and radiographic data and device-associated charges of 45 consecutive patients in whom a virtual “stroke bundle” model was used to purchase mechanical thrombectomy devices.RESULTSUse of the stroke bundle to purchase mechanical thrombectomy devices resulted in an average savings per case of $2900.93. Compared to the traditional model of charging for devices à la carte, this represented an average savings of 25.2% per case. The total amount of savings for these initial 45 cases was $130,542.00. Thrombolysis in Cerebral Infarction scale grade 2b or 3 recanalization occurred in 38 patients (84.4%) using these devices.CONCLUSIONSPurchasing devices through a bundled model resulted in substantial cost savings while maintaining the therapeutic efficacy of the procedure, further pushing the already beneficial long-term cost-benefit curve in favor of thrombectomy.

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Abstract P589: Pediatric Thrombectomy: Design And Workflow Lessons From Two Experienced Centers

Stroke ◽

10.1161/str.52.suppl_1.p589 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

David C Lauzier ◽

Maria M Galardi ◽

Kristin Guilliams ◽

Manu S Goyal ◽

Catherine Amlie-Lefond ◽

...

Keyword(s):

Case Reports ◽

Quality Care ◽

Stroke Care ◽

Outcome Data ◽

Hospital Environment ◽

Pediatric Stroke ◽

Endovascular Thrombectomy ◽

Stroke Imaging ◽

Workflow Integration ◽

Low Incidence

Introduction: While clinical trials have demonstrated the remarkable efficacy of endovascular thrombectomy (EVT) for treating adult patients suffering from acute ischemic stroke (AIS), benefits reaped from advances in adult stroke care have unfortunately not occurred in parallel with pediatric stroke care. Randomized trials of EVT in childhood stroke are unlikely given the low incidence of stroke in children compared to adults, and despite promising outcomes in small case reports and series, EVT in children remains an off-label procedure lacking established consensus guidelines. Along with a clear need to collect prospective pediatric EVT outcome data, there is a need to enhance pediatric stroke care infrastructure to provide high-quality care to children experiencing stroke. Methods: In this work, we review two successful pediatric thrombectomy programs, examining key workflow design features that are likely to be important for other programs that aspire to implement pediatric EVT capability. Discussion: While pediatric EVT workflows will vary between centers, we identify several key elements of programmatic success shared between the two reviewed stroke programs that may serve as foundational design considerations for centers aiming to develop their own pediatric EVT programs. These elements include a formalized protocol and workflow, integration with an adult EVT workflow, simplification and automation of workflow steps, pediatric adaptations of stroke imaging, advocacy of pediatric stroke care, and collaboration between providers, among others. These essential features transcend any single hospital environment and may provide an important foundation for other pediatric centers that aim to enhance the care of children with stroke. Conclusion: EVT shows promise in reducing stroke-associated morbidity in children. To maximize the efficacy of this intervention, workflow optimizations discussed here should be implemented by centers seeking to develop local pediatric EVT capability.

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Abstract 185: Residual Stroke Morbidity and Post-acute Care Cost: the IMS III Economic Data Cohort

Stroke ◽

10.1161/str.47.suppl_1.185 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Kit N Simpson ◽

Annie N Simpson ◽

Michael D Hill ◽

Yuko Y Palesh ◽

Edward C Jauch ◽

...

Keyword(s):

Hospital Readmissions ◽

Cost Savings ◽

Stroke Care ◽

Office Visits ◽

Economic Data ◽

Post Discharge ◽

Post Stroke ◽

Initial Hospital ◽

The Cost

Introduction: The IMS III trial included 1-year follow-up with prospectively collected data on resource use after stroke. While the trial showed no difference in 90-day clinical outcomes by treatment group, this cohort provides invaluable information on cost variations associated with post-stroke morbidity. We report the effect of residual stroke morbidity on cost of stroke care after discharge at 12 months post stroke. Methods: Among 470 subjects with moderate to severe stroke for whom economic data were collected (316 randomized to IV t-PA and endovascular therapy, 154 to IV t-PA alone), we estimated cumulative cost post discharge using cost weights derived from a 5% sample of US Medicare patients in 2012 with an admission for acute ischemic stroke with IV t-PA treatment. Cost weights included post-stroke rehabilitation hospital days, emergency care visits, hospital readmissions, medical office visits, rehabilitation therapy visits and nursing home days. Costs were summed at the level of the subject and estimated for the subset defined by NIH Stroke Scale Score (NIHSS) at day 5, and Modified Rankin Score (mRS) and Barthel Index (BI) at 3 months post stroke. Subjects who died during the initial hospital admission or who had no score at day 5 or at 3 months were not included in our analysis. Age-adjusted, log-transformed costs were compared. Results: There was a 6 fold difference in the cost of follow-up care by lowest and highest NIHSS at day 5 (p<.0001). Similarly large differences by outcome category were observed for both the mRS (p<.0001) groups and subjects defined by the BI (p<.0001) at 3 months (see Figure). Conclusion: Residual stroke morbidity has a large effect on the long-term cost of stroke care, with an effect size of over 600%. Interventions that improve the residual morbidity after stroke as early as day 5 may be expected to result in substantial post discharge cost savings.

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Does Spasticity Itself Raise the Cost of Stroke Care 4-Fold?

Stroke ◽

10.1161/strokeaha.110.581561 ◽

2010 ◽

Vol 41 (7) ◽

Author(s):

Bruce H. Dobkin

Keyword(s):

Stroke Care ◽

The Cost

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The Cost of Pediatric Stroke Acute Care in the United States

Stroke ◽

10.1161/strokeaha.109.548156 ◽

2009 ◽

Vol 40 (8) ◽

pp. 2820-2827 ◽

Cited By ~ 36

Author(s):

Elizabeth Perkins ◽

Julie Stephens ◽

Huiyun Xiang ◽

Warren Lo

Keyword(s):

United States ◽

Acute Care ◽

The United States ◽

Pediatric Stroke ◽

The Cost

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Implementing the NHS England Long Term Plan for stroke: how should reperfusion services be configured? A modelling study

10.31219/osf.io/yg3x8 ◽

2021 ◽

Author(s):

Michael Allen ◽

Kerry Pearn ◽

Gary A. Ford ◽

Phil White ◽

Anthony Rudd ◽

...

Keyword(s):

Acute Stroke ◽

Computer Modelling ◽

Systems Of Care ◽

Stroke Care ◽

Net Benefit ◽

Acute Stroke Care ◽

Modest Improvement ◽

Secondary Transfer ◽

The Cost ◽

The Impact

Objectives: To guide policy when planning reperfusion thrombolysis (IVT) and thrombectomy (MT) services for acute stroke in England, focussing on the choice between ‘mothership’ (direct conveyance to an MT centre) and ‘drip-and-ship' (secondary transfer for MT after local IVT) provision and the impact of bypassing local acute stroke centres.Methods: Computer modelling was used to estimate the likely outcomes from reperfusion therapies, along with admission numbers to units, based on expected times to IVT and MT.Results: Without pre-hospital selection for LAO, 94% of the population of England live in areas where the greatest clinical benefit accrues from direct conveyance to an IVT/MT centre. If this model was followed then net benefit from reperfusion is predicted to be increased from 31 to 34 additional disability-free outcomes / 1,000 admissions. However, this policy produces unsustainable admission numbers at these centres, and depletes all but 19 IVT-only units of all stroke admissions. Implementing a maximum permitted additional travel time to bypass an IVT-only unit, or using a pre-hospital test for LAO, both increase net benefit over the current drip-and-ship model, but produce a similar destabilising effect on acute systems of care. Use of IVT-only units manage admission numbers to IVT/MT centres.Conclusions: The mothership model reduces time to MT at the cost of increased time to IVT, but the benefit of faster MT is predicted to lead to a modest improvement in overall outcomes. Providing a sustainable national system of acute stroke care requires a hybrid of mothership and drip-and-ship provision.

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Cost burden and cost-effective analysis of the nationwide implementation of the Quality in Acute Stroke Care protocol in Australia

European Heart Journal ◽

10.1093/eurheartj/ehab724.3157 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

C M Marquina ◽

Z A Ademi ◽

E Z Zomer ◽

R O A Ofori-Asenso ◽

R T Tate ◽

...

Keyword(s):

Acute Stroke ◽

Societal Perspective ◽

Stroke Care ◽

Decision Analytic Model ◽

Stroke Severity ◽

Acute Stroke Care ◽

Stroke Incidence ◽

Care Protocol ◽

Life Years ◽

The Cost

Abstract Background The Quality in Acute Stroke Care (QASC) protocol is a multidisciplinary approach to implement evidence-based treatment after acute stroke that reduces death and disability. Aim This study sought to evaluate the cost-effectiveness of implementing the QASC protocol across Australia, from a healthcare and a societal perspective. Methods A decision-analytic model was constructed to reflect one-year outcomes post-stroke, aligned with the stroke severity categories of the modified Rankin scale (mRS). Decision analysis compared outcomes following implementation of the QASC protocol versus no implementation. Population data were extracted from Australian databases and data inputs regarding stroke incidence, costs, and utilities were drawn from published sources. The analysis assumed a progressive uptake and efficacy of the QASC protocol over five years. Health benefits and costs were discounted by 5% annually. The cost of each year lived by an Australian, from a societal perspective, was based on the Australian Government's “value of statistical life year” (AUD 213,000). Results Over five years, the model predicted 263,722 strokes among the Australian population. The implementation of the QASC protocol was predicted to prevent 1,154 deaths and yield a gain of 876 years of life (0.003 per stroke), and 3,180 quality-adjusted life years (QALYs) (0.012 per stroke). There was an estimated net saving of AUD 65.2 million in healthcare costs (AUD 247 per stroke) and AUD 251.7 million in societal costs (AUD 955 per stroke). Conclusions Implementation of the QASC protocol in Australia represents both a dominant (cost-saving) strategy, from a healthcare and a societal perspective. FUNDunding Acknowledgement Type of funding sources: None. Decision tree PSA

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