Journal article
Observed Cost and Variations in Short Term Cost-Effectiveness of Therapy for Ischemic Stroke in Interventional Management of Stroke (IMS) III
Journal of the American Heart Association, Vol.6(5)
05/08/2017
DOI: 10.1161/JAHA.116.004513
PMCID: PMC5524059
PMID: 28483774
Abstract
Examination of linked data on patient outcomes and cost of care may help identify areas where stroke care can be improved. We report on the association between variations in stroke severity, patient outcomes, cost, and treatment patterns observed over the acute hospital stay and through the 12-month follow-up for subjects receiving endovascular therapy compared to intravenous tissue plasminogen activator alone in the IMS (Interventional Management of Stroke) III Trial.
Prospective data collected for a prespecified economic analysis of the trial were used. Data included hospital billing records for the initial stroke admission and subsequent detailed resource use after the acute hospitalization collected at 3, 6, 9, and 12 months. Cost of follow-up care varied 6-fold for patients in the lowest (0-1) and highest (20+) National Institutes of Health Stroke Scale category at 5 days, and by modified Rankin Scale at 3 months. The kind of resources used postdischarge also varied between treatment groups. Incremental short-term cost-effectiveness ratios varied greatly when treatments were compared for patient subgroups. Patient subgroups predefined by stroke severity had incremental cost-effectiveness ratios of $97 303/quality-adjusted life year (severe stroke) and $3 187 805/quality-adjusted life year (moderately severe stroke).
Detailed economic and resource utilization data from IMS III provide powerful evidence for the large effect that patient outcome has on the economic value of medical and endovascular reperfusion therapies. These data can be used to inform process improvements for stroke care and to estimate the cost-effectiveness of endovascular therapy in the US health system for stroke intervention trials.
URL: http://www.clinicaltrials.gov. Registration number: NCT00359424.
Details
- Title: Subtitle
- Observed Cost and Variations in Short Term Cost-Effectiveness of Therapy for Ischemic Stroke in Interventional Management of Stroke (IMS) III
- Creators
- Kit N Simpson - Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC simpsonk@musc.eduAnnie N Simpson - Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SCPatrick D Mauldin - Department of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SCYuko Y Palesch - Department of Public Health Sciences, Medical University of South Carolina, Charleston, SCSharon D Yeatts - Department of Public Health Sciences, Medical University of South Carolina, Charleston, SCDawn Kleindorfer - Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OHThomas A Tomsick - Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OHLydia D Foster - Department of Public Health Sciences, Medical University of South Carolina, Charleston, SCAndrew M Demchuk - Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, CanadaPooja Khatri - Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OHMichael D Hill - Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, CanadaEdward C Jauch - Division of Emergency Medicine, Medical University of South Carolina, Charleston, SCTudor G Jovin - Stroke Institute, University of Pittsburgh Medical Center, Pittsburgh, PABernard Yan - Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, AustraliaRüdiger von Kummer - Institute of Diagnostic and Interventional Neuroradiology, University Hospital Dresden, Dresden, GermanyCarlos A Molina - Neurovascular Unit, Department of Neurology, Hospital Universitari Vall d'Hebron, Barcelona, SpainMayank Goyal - Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, CanadaWouter J Schonewille - St. Antonius Hospital, Nieuwegein, The NetherlandsMikael Mazighi - Department of Neurology and Stroke Center, Lariboisière Hospital, DHU NeuroVasc, Paris, FranceStefan T Engelter - University Center for Medicine of Aging, Felix Platter Hospital, Basel, SwitzerlandCraig Anderson - George Institute for Global Health, Royal Prince Alfred Hospital, University of Sydney, Sydney, AustraliaJudith Spilker - Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OHJanice Carrozzella - Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OHKarla J Ryckborst - Calgary Stroke Program, Departments of Clinical Neurosciences and Radiology, Seaman Family MR Research Centre, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, CanadaL Scott Janis - National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MDJoseph P Broderick - Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Gardner Neuroscience Institute University of Cincinnati Academic Health Center, Cincinnati, OHInterventional Management of Stroke (IMS) III Investigators
- Contributors
- Colin P Derdeyn (Contributor) - University of Iowa, Radiology
- Resource Type
- Journal article
- Publication Details
- Journal of the American Heart Association, Vol.6(5)
- DOI
- 10.1161/JAHA.116.004513
- PMID
- 28483774
- PMCID
- PMC5524059
- NLM abbreviation
- J Am Heart Assoc
- ISSN
- 2047-9980
- eISSN
- 2047-9980
- Publisher
- England
- Grant note
- UL1 TR001450 / NCATS NIH HHS
- Language
- English
- Date published
- 05/08/2017
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984013921802771
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