Real-life costs and effects of an implementation program to increase thrombolysis in stroke.
OBJECTIVE
We have shown that a Breakthrough Series-based implementation program increases the number of patients with acute ischemic stroke treated with alteplase 4.5% in real-life settings. It is unclear whether such an implementation program is cost-effective.


METHODS
The practice study includes 12 randomized hospitals and 5,515 patients. Its present cost-effectiveness analysis involves 1,657 patients with ischemic stroke admitted within 4 hours from onset. Defined primary outcomes are thrombolysis rate and actual health care costs up to 3 months, including additional implementation efforts. Secondary outcomes are lifetime quality-adjusted years (QALYs) and lifetime costs of individual trial patients, using a validated probabilistic, disability-stratified stroke life table. Differences in outcome include 95% confidence intervals (CI), adjusted for intracluster correlation.


RESULTS
The thrombolysis rate in the intervention group was 44.3% vs 39.8% in the control group (difference 4.5%; 95% CI 3.1% to 5.9%. Mean costs per patient at 3 months (euros were converted to 2010 USD) were $9,192 USD in the intervention group and $9,647 USD in the control group (difference -$455 USD; 95% CI -$232 to -$679 USD). Lifetime QALYs in the intervention group were 3.89 and in the control group 3.84 (difference 0.05; 95% CI -0.04 to 0.14). The mean lifetime costs in the intervention group were $22,994 USD against $24,315 USD in the control group (difference -$1,321 USD; 95% CI -$1,722 to -$921 USD).


CONCLUSIONS
A Breakthrough Series implementation program of thrombolysis increases thrombolysis. It saves short- and long-term health care costs due to lower hospital admission and residential costs, increasing stroke care efficiency.
Department of Neurology, Erasmus MC University Hospital Rotterdam, Rotterdam, UK. m.dirks@erasmusmc.nl
Maaike
M
Dirks
Stefan A
SA
Baeten
Diederik W J
DW
Dippel
N Job A
NJ
van Exel
Jeroen D H
JD
van Wijngaarden
Robbert
R
Huijsman
Peter J
PJ
Koudstaal
Louis W
LW
Niessen
D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D008297:Male; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000188:drug therapy* / Q000191:economics*; D015912:Thrombolytic Therapy / Q000191:economics*