Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life.
OBJECTIVE
Stroke is very common, but computed tomography (CT) scanning, an expensive and finite resource, is required to differentiate cerebral infarction, hemorrhage, and stroke mimics. We determined whether, and in what circumstances, CT is cost-effective in acute stroke.


METHODS
We developed a decision tree representing acute stroke care pathways populated with data from multiple sources. We determined the effect of diagnostic information from CT scanning on functional outcome, length of stay, costs, and quality of life during 5 years for 13 alternative CT strategies (varying proportions and types of patients and rapidity of scanning).


RESULTS
For 1000 patients aged 70 to 74 years, the policy "scan all strokes within 48 hours" cost 10,279,728 pounds sterling and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (9,993,676 pounds sterling and 1982.4 QALYs). The least cost-effective was "scan patients on anticoagulants and those in a life-threatening condition immediately and the rest within 14 days" (12,592,666 pounds sterling and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (10,544,000 pounds sterling).


CONCLUSIONS
Immediate CT scanning is the most cost-effective strategy. For the majority of acute stroke patients, increasing independent survival by correct early diagnosis, ensuring appropriate subsequent treatment and management decisions, reduced costs of stroke and increased QALYs.
Division of Clinical Neurosciences, Western General Hospital, Crewe Rd, Edinburgh, EH4 2XY, UK. jmw@skull.dcn.ed.ac.uk
Joanna M
JM
Wardlaw
Janelle
J
Seymour
John
J
Cairns
Sarah
S
Keir
Steff
S
Lewis
Peter
P
Sandercock
D000368:Aged; D003362:Cost-Benefit Analysis; D019091:Critical Pathways; D003663:Decision Trees; D006801:Humans; D007902:Length of Stay; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000000981:diagnostic imaging* / Q000191:economics* / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000191:economics*; D006113:United Kingdom