Cost-effectiveness of targeted thrombolytic therapy for stroke patients using multi-modal CT compared to usual practice

Abstract Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours.Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model.Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA.Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

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Economic evaluations of health care interventions in Oropharyngeal Dysphagia after Stroke: Protocol for a Systematic Review.

10.21203/rs.3.rs-376486/v1 ◽

2021 ◽

Author(s):

Sergio Marin ◽

Mateu Serra-Prat ◽

Omar Ortega ◽

Pere Clavé

Keyword(s):

Systematic Review ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Oropharyngeal Dysphagia ◽

Cost Savings ◽

Economic Evaluations ◽

Stroke Patients ◽

Post Stroke ◽

Healthcare Interventions ◽

The Cost

Abstract Background and purpose: Oropharyngeal Dysphagia (OD) affects 40-81% of patients after stroke. A recent systematic review on the costs of OD and it’s main complications showed higher acute and long-term costs for those patients who developed OD, malnutrition and pneumonia after stroke. These results suggest that appropriate management of post-stroke OD could lead to reduction of clinical complications and significant cost savings. The purpose of this systematic review is to assess the available literature exploring the efficiency or cost-effectiveness of available healthcare interventions on the appropriate management of OD. Methods: A systematic review on economic evaluations of health care interventions on post-stroke patients with OD following PRISMA recommendations will be performed. MEDLINE, Embase, the National Health Service Economic Evaluation Database and the Cost-Effectiveness Analysis Registry Database will be searched and a subsequent reference check will be done. English and Spanish literature will be included without date restrictions. Studies will be included if they refer to economic evaluations or studies in which cost savings were reported in post-stroke patients suffering OD. Studies will be excluded if they are partial economic evaluation studies, if they refer to esophageal dysphagia, or if OD is caused by causes different from stroke. Evidence will be presented and synthetized with a narrative method and using tables. Quality evaluation will be done using Consolidated Health Economic Evaluation Reporting Standards (CHEERS) Statement. Discussion: The protocol for this systematic review is the first step to assess the cost-effectiveness of the healthcare interventions that have been described as potential treatments for post-stroke OD. This systematic review will summarize the current evidence on the relation between cost and benefits associated with the appropriate management of OD in post-stroke patients. Systematic review registration: PROSPERO CRD42020136245

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Cost-Effectiveness of Treating Romanian Post-Stroke Patients with Upper Limb Spasticity With Incobotulinumtoxin-A Against Conventional Therapy

Value in Health ◽

10.1016/j.jval.2018.04.1405 ◽

2018 ◽

Vol 21 ◽

pp. S206-S207 ◽

Cited By ~ 1

Author(s):

A Turcu-Stiolica ◽

M Subtirelu

Keyword(s):

Cost Effectiveness ◽

Upper Limb ◽

Conventional Therapy ◽

Stroke Patients ◽

Post Stroke ◽

Limb Spasticity ◽

Incobotulinumtoxin A

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Thrombolytic therapy in ischemic stroke patients with pre-stroke depression in the telestroke vs non-telestroke

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2020.104890 ◽

2020 ◽

Vol 29 (9) ◽

pp. 104890 ◽

Cited By ~ 1

Author(s):

Robyn Moraney ◽

Nicolas Poupore ◽

Rachel Shugart ◽

Mandy Tate ◽

Ashley Snell ◽

...

Keyword(s):

Ischemic Stroke ◽

Thrombolytic Therapy ◽

Stroke Patients

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12 Potential cost-effectiveness of spectral photon-counting computed tomography (SPCCT) versus CT combined with CT angiography (CTA) in the identification and treatment of ischaemic stroke patients in the UK

10.1136/postgradmedj-2018-fpm.23 ◽

2018 ◽

Author(s):

Anne Claire Peultier ◽

Ken Redekop ◽

Hans Severens

Keyword(s):

Computed Tomography ◽

Cost Effectiveness ◽

Ischaemic Stroke ◽

Ct Angiography ◽

Photon Counting ◽

Stroke Patients ◽

Potential Cost ◽

The Uk

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Protocol for economic evaluation alongside the SHINE (Supporting Healthy Image, Nutrition and Exercise) cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2020-038050 ◽

2020 ◽

Vol 10 (8) ◽

pp. e038050

Author(s):

Victoria Brown ◽

Joanne Williams ◽

Lisa McGivern ◽

Susan Sawyer ◽

Liliana Orellana ◽

...

Keyword(s):

Body Image ◽

Economic Evaluation ◽

Cost Effectiveness ◽

Incremental Cost ◽

Randomised Control Trial ◽

Usual Practice ◽

Cluster Randomised ◽

Life Years ◽

The Difference ◽

Intervention Costs

IntroductionLimited evidence exists on the cost-effectiveness of interventions to prevent obesity and promote healthy body image in adolescents. The SHINE (Supporting Healthy Image, Nutrition and Exercise) study is a cluster randomised control trial (cRCT) aiming to deliver universal education about healthy nutrition and physical activity to adolescents, as well as targeted advice to young people with body image concerns who are at risk of developing disordered eating behaviours. This paper describes the methods for the economic evaluation of the SHINE cRCT, to determine whether the intervention is cost-effective as an obesity prevention measure.Methods and analysisA public payer perspective will be adopted, with intervention costs collected prospectively. Within-trial cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) will quantify the incremental costs and health gains of the intervention as compared with usual practice (ie, teacher-delivered curriculum). CEA will present results as cost per body mass index unit saved. CUA will present results as cost per quality-adjusted life year gained. A modelled CUA will extend the target population, time horizon and decision context to provide valuable information to policymakers on the potential for incremental cost offsets attributable to disease prevention arising from intervention. Intervention costs and effects will be extrapolated to the population of Australian adolescents in Grade 7 of secondary school (approximate age 13 years) and modelled over the cohort’s lifetime. Modelled CUA results will be presented as health-adjusted life years saved and healthcare cost-savings of diseases averted. Incremental cost-effectiveness ratios will be calculated as the difference in costs between the intervention and comparator divided by the difference in benefit. Semi-structured interviews with key intervention stakeholders will explore the potential impact of scalability on cost-effectiveness. These data will be thematically analysed to inform sensitivity analysis of the base case economic evaluation, such that cost-effectiveness evidence is reflective of the potential for scalability.Ethics and disseminationEthics approval was obtained from the Deakin University Human Research Ethics Committee (#2017–269) and the Victorian Department of Education and Training (#2018_003630). Study findings will be disseminated through peer-reviewed academic papers and participating schools will receive annual reports over the 3 years of data collection.Trial registration numberACTRN 12618000330246; Pre-results.

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