The cost-effectiveness of primary stroke centers for acute stroke care.

Abstract

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. 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. 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. 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.