title: The cost-effectiveness of primary stroke centers for acute stroke care.
abstract: OBJECTIVE
  Primary stroke centers (PSC) have demonstrated improved survival in patients with acute ischemic stroke (AIS). The objective of this study was to evaluate the cost-effectiveness of treating AIS patients in a PSC compared with a nonPSC hospital setting.
  
  
  METHODS
  We developed a decision analytic model to project the lifetime outcomes and costs of 2 hypothetical cohorts of 75 AIS patients. Clinical data were derived from a recent observational study comparing PSC- and nonPSC-admitted patients, clinical trials, longitudinal cohort studies, and health state preference studies. Cost data were based on Medicare reimbursement and other published sources. We used a healthcare payer perspective, and the primary outcomes were incremental life expectancy, quality-adjusted life years, and healthcare costs. We performed sensitivity and scenario analyses to evaluate uncertainty in the results.
  
  
  RESULTS
  Admission to a PSC resulted in a gain of 0.22 years of life (95% credible range [CR], 0.12-0.33) and 0.15 quality-adjusted life years (95% CR, 0.08-0.23) per patient, at a cost of $3600 (95% CR, $2400-$5000) per patient, compared with admission to a nonPSC hospital. The incremental cost/quality-adjusted life year gained was $24 000, and all probabilistic simulation results were below the $100 000/quality-adjusted life year threshold. In scenario analyses accounting for as few as 7 and as many as 500 AIS patients/year per PSC, cost-effectiveness improved as the number of AIS patients admitted per year increased.
  
  
  CONCLUSIONS
  Our study indicates that care at a PSC for patients with AIS is cost-effective and improves outcomes across a wide range of possible scenarios.
authors.affiliation: University of Washington, Seattle, WA 98195,USA.
authors.forename: Gregory F
authors.initials: GF
authors.lastname: Guzauskas
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Villa
authors.forename: Steven R
authors.initials: SR
authors.lastname: Levine
authors.forename: David L
authors.initials: DL
authors.lastname: Veenstra
mesh_terms: D000554:Ambulatory Care Facilities / Q000191:economics*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011788:Quality of Life; D020521:Stroke / Q000191:economics* / Q000628:therapy*