Immediate Computed Tomography Scanning of Acute Stroke Is Cost-Effective and Improves Quality of Life

Abstract

Background and Purpose-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 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (£9 993 676 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 and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (£10 544 000). Conclusion-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.

Multimodal Imaging Does Not Delay Intravenous Thrombolytic Therapy in Acute Stroke

“…In 1000 patients 70 -74 years of age with acute stroke, the most costeffective strategy was to scan all patients immediately (reducing costs and increasing independent survival) versus scanning immediately only patients on anticoagulants or having life-threatening conditions, or scanning no patients immediately. 16 Three primary disadvantages to performing multimodal imaging before the decision for IV tPA exist. First, there is the potential for delayed treatment with IV tPA because the scanning/processing times are shorter for unenhanced CT versus multimodal imaging (approximately 5 minutes versus 15 minutes, respectively), and the sooner IV tPA can be given the greater the benefit.…”

Systematic Review, Critical Appraisal, and Analysis of the Quality of Economic Evaluations in Stroke Imaging

“…All studies used noncontrast CT (NCCT) as the base case imaging modality to select patients for intravenous thrombolysis. [19][20][21][22][23] One study by guest on May 7, 2018 http://stroke.ahajournals.org/ Downloaded from used CT perfusion (CTP), 23 and another used MRI as the comparator 19 ( Table 1). The third used both CTP and MRI as comparators, but not in combination.…”

“…21 The fifth study focused on NCCT only, with the base case being NCCT administered at 48 hours and the comparators being NCCT used at different time points after symptom onset, and in patients with different comorbidities. 22 Of the 5 studies reviewed, 4 did not explicitly publish ICERs but provided adequate data for ICERs to be calculated [20][21][22][23] ( Table 2). In 3 studies, NCCT was dominated by ≥1 proposed alternative imaging strategy; that is, the alternative was both cheaper and more effective.…”

“…20,21,23 The study that compared NCCT at 48 hours to 12 other NCCT strategies determined that the scan-all-patients-immediately strategy delivered a lower cost but lower benefit. 22 Another study that compared NCCT with MRI with NCCT alone showed that both the cost and benefit of the combined imaging strategy were higher. 19 Finally, when NCCT with MRI was compared with NCCT alone in another study, the overall cost of using NCCT with MRI was cheaper yet demonstrated an identical effect to NCCT.…”

Modern complex non-invasive methods for diagnosing ischemic disorders of cerebral circulation

“…Noncontrast computed tomography of the brain is a widely available method, providing for reliable CI diagnosing and its being distinguished from brain haemorrage in the first few days after occurrence (2,3).…”