The cost effectiveness of increasing thrombolysis rates to treat acute stroke
- Stroke is a leading cause of morbidity and mortality worldwide, with an estimated 5.7 million deaths and 50 million disability-adjusted life years lost every year, with many patients requiring longterm care.
- Thrombolysis in acute stroke is an effective treatment up to 4.5 hours after onset, but relies on early recognition, prompt arrival in hospital and timely brain scanning.
- Delays at any stage of the pathway reduce the proportion of patients that receive thrombolysis.
- Efforts to expedite the acute stroke care pathway have been made, but it is unclear whether these strategies are cost-effective and/ or beneficial to patient outcomes.
- This study aimed to est
- A series of strategies to reduce delay in receiving thrombolysis were analysed for their cost - effectiveness by examining the cost of the strategy per quality -adjusted life year (QALY) gained.
- The strategies included more timely referrals and CT scans, and it was found that all the intervention strategies were cost -effective because of a reduction in dependency after stroke and subsequent reduction in long -term care costs.
- The largest cost reduction was the strategy of immediate CT scan upon arrival, with a saving of US$75,000 and an additional 5.4 QALYs per 100,000 population
- The most achievable strategy with the largest potential benefit was that of better recording of stroke symptom onset time. This resulted in 3.3 additional QALYs and a cost saving of US$46,000 per 100,000 population.
- An enhanced electronic pro forma has been developed for use by all paramedics in the West Midlands Ambulance Service to include ‘time of onset’ in the Face Arm Speech Test (FAST) – an assessment tool used to improve paramedic recognition of suspected stroke to both improve reporting rates and to facilitate more efficient in -hospital care.