title: Cost avoidance associated with optimal stroke care in Canada.
abstract: OBJECTIVE
  Evidence-based stroke care has been shown to improve patient outcomes and may reduce health system costs. Cost savings, however, are poorly quantified. This study assesses 4 aspects of stroke management (rapid assessment and treatment services, thrombolytic therapy, organized stroke units, and early home-supported discharge) and estimates the potential for cost avoidance in Canada if these services were provided in a comprehensive fashion.
  
  
  METHODS
  Several independent data sources, including the Canadian Institute of Health Information Discharge Abstract Database, the 2008-2009 National Stroke Audit, and the Acute Cerebrovascular Syndrome Registry in the province of British Columbia, were used to assess the current status of stroke care in Canada. Evidence from the literature was used to estimate the effect of providing optimal stroke care on rates of acute care hospitalization, length of stay in hospital, discharge disposition (including death), changes in quality of life, and costs avoided.
  
  
  RESULTS
  Comprehensive and optimal stroke care in Canada would decrease the number of annual hospital episodes by 1062 (3.3%), the number of acute care days by 166 000 (25.9%), and the number of residential care days by 573 000 (12.8%). The number of deaths in the hospital would be reduced by 1061 (14.9%). Total avoidance of costs was estimated at $682 million annually ($307.4 million in direct costs, $374.3 million in indirect costs).
  
  
  CONCLUSIONS
  The costs of stroke care in Canada can be substantially reduced, at the same time as improving patient outcomes, with the greater use of known effective treatment modalities.
authors.affiliation: School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. hans@krueger.ca
authors.forename: Hans
authors.initials: H
authors.lastname: Krueger
authors.forename: Patrice
authors.initials: P
authors.lastname: Lindsay
authors.forename: Robert
authors.initials: R
authors.lastname: Cote
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
authors.forename: Janusz
authors.initials: J
authors.lastname: Kaczorowski
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications / Q000191:economics / Q000453:epidemiology; D002170:Canada; D002543:Cerebral Hemorrhage / Q000150:complications / Q000191:economics / Q000453:epidemiology; D003363:Cost Control / Q000379:methods*; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D015233:Models, Statistical; D019057:Quality-Adjusted Life Years; D012042:Registries; D020521:Stroke / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome