Simpson Kit N, Simpson Annie N, Mauldin Patrick D, Palesch Yuko Y, Yeatts Sharon D, Kleindorfer Dawn, Tomsick Thomas A, Foster Lydia D, Demchuk Andrew M, Khatri Pooja, Hill Michael D, Jauch Edward C, Jovin Tudor G, Yan Bernard, von Kummer Rüdiger, Molina Carlos A, Goyal Mayank, Schonewille Wouter J, Mazighi Mikael, Engelter Stefan T, Anderson Craig, Spilker Judith, Carrozzella Janice, Ryckborst Karla J, Janis L Scott, Broderick Joseph P
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC.
J Am Heart Assoc. 2017 May 8;6(5):e004513. doi: 10.1161/JAHA.116.004513.
Examination of linked data on patient outcomes and cost of care may help identify areas where stroke care can be improved. We report on the association between variations in stroke severity, patient outcomes, cost, and treatment patterns observed over the acute hospital stay and through the 12-month follow-up for subjects receiving endovascular therapy compared to intravenous tissue plasminogen activator alone in the IMS (Interventional Management of Stroke) III Trial.
Prospective data collected for a prespecified economic analysis of the trial were used. Data included hospital billing records for the initial stroke admission and subsequent detailed resource use after the acute hospitalization collected at 3, 6, 9, and 12 months. Cost of follow-up care varied 6-fold for patients in the lowest (0-1) and highest (20+) National Institutes of Health Stroke Scale category at 5 days, and by modified Rankin Scale at 3 months. The kind of resources used postdischarge also varied between treatment groups. Incremental short-term cost-effectiveness ratios varied greatly when treatments were compared for patient subgroups. Patient subgroups predefined by stroke severity had incremental cost-effectiveness ratios of $97 303/quality-adjusted life year (severe stroke) and $3 187 805/quality-adjusted life year (moderately severe stroke).
Detailed economic and resource utilization data from IMS III provide powerful evidence for the large effect that patient outcome has on the economic value of medical and endovascular reperfusion therapies. These data can be used to inform process improvements for stroke care and to estimate the cost-effectiveness of endovascular therapy in the US health system for stroke intervention trials.
URL: http://www.clinicaltrials.gov. Registration number: NCT00359424.
对患者预后与医疗成本的关联数据进行研究，可能有助于确定可改善卒中治疗的领域。我们报告了在IMS（卒中介入管理）III试验中，接受血管内治疗的患者与仅接受静脉注射组织纤溶酶原激活剂的患者相比，在急性住院期间及12个月随访中观察到的卒中严重程度、患者预后、成本及治疗模式的差异之间的关联。
使用为该试验预先指定的经济分析收集的前瞻性数据。数据包括首次卒中入院的医院计费记录，以及急性住院后在3、6、9和12个月收集的后续详细资源使用情况。在第5天，最低（0 - 1）和最高（20+）美国国立卫生研究院卒中量表类别患者的随访护理成本相差6倍，在3个月时按改良Rankin量表计算也存在差异。出院后使用的资源种类在治疗组之间也有所不同。当比较不同患者亚组的治疗时，短期增量成本效益比差异很大。按卒中严重程度预先定义的患者亚组的增量成本效益比为97303美元/质量调整生命年（严重卒中）和3187805美元/质量调整生命年（中度严重卒中）。
IMS III的详细经济和资源利用数据为患者预后对药物和血管内再灌注治疗的经济价值产生的巨大影响提供了有力证据。这些数据可用于为卒中治疗的流程改进提供信息，并估计在美国卫生系统中血管内治疗用于卒中干预试验的成本效益。
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