Ajmi Soffien Chadli, Kurz Martin W, Ersdal Hege, Lindner Thomas, Goyal Mayank, Issenberg S Barry, Vossius Corinna
Department of Neurology, Stavanger University Hospital, Stavanger, Norway
Faculty of Health Sciences, Universitetet i Stavanger, Stavanger, Norway.
BMJ Qual Saf. 2022 Aug;31(8):569-578. doi: 10.1136/bmjqs-2021-013398. Epub 2021 Oct 1.
Rapid revascularisation in acute ischaemic stroke is crucial to reduce its total burden including societal costs. A quality improvement (QI) project that included streamlining the stroke care pathway and simulation-based training was followed by a significant reduction in median door-to-needle time (27 to 13 min) and improved patient outcomes after stroke thrombolysis at our centre. Here, we present a retrospective cost-effectiveness analysis of the QI project.
Costs for implementing and sustaining QI were assessed using recognised frameworks for economic evaluations. Effectiveness was calculated from previously published outcome measures. Cost-effectiveness was presented as incremental cost-effectiveness ratios including costs per minute door-to-needle time reduction per patient, and costs per averted death in the 13-month post-intervention period. We also estimated incremental cost-effectiveness ratios for a projected 5-year post-intervention period and for varying numbers of patients treated with thrombolysis. Furthermore, we performed a sensitivity analysis including and excluding costs of unpaid time.
All costs including fixed costs for implementing the QI project totalled US$44 802, while monthly costs were US$2141. We calculated a mean reduction in door-to-needle time of 13.1 min per patient and 6.36 annual averted deaths. Across different scenarios, the estimated costs per minute reduction in door-to-needle time per patient ranged from US$13 to US$29, and the estimated costs per averted death ranged from US$4679 to US$10 543.
We have shown that a QI project aiming to improve stroke thrombolysis treatment at our centre can be implemented and sustained at a relatively low cost with increasing cost-effectiveness over time. Our work builds on the emerging theory and practice for economic evaluations in QI projects and simulation-based training. The presented cost-effectiveness data might help guide healthcare leaders planning similar interventions.
急性缺血性卒中的快速血管再通对于减轻其总体负担（包括社会成本）至关重要。一项质量改进（QI）项目，包括简化卒中护理流程和基于模拟的培训，之后我们中心的中位门到针时间显著缩短（从27分钟降至13分钟），且卒中溶栓治疗后的患者预后得到改善。在此，我们展示该QI项目的回顾性成本效益分析。
使用公认的经济评估框架评估实施和维持QI的成本。有效性根据先前发表的结果指标计算。成本效益以增量成本效益比表示，包括每位患者门到针时间每减少一分钟的成本，以及干预后13个月内每避免一例死亡的成本。我们还估计了干预后预计5年期间以及不同溶栓治疗患者数量的增量成本效益比。此外，我们进行了敏感性分析，包括计入和不计入无薪时间成本。
包括实施QI项目的固定成本在内的所有成本总计44,802美元，而每月成本为2141美元。我们计算出每位患者的门到针时间平均减少13.1分钟，每年避免6.36例死亡。在不同情景下，每位患者门到针时间每减少一分钟的估计成本在13美元至29美元之间，每避免一例死亡的估计成本在4679美元至10,543美元之间。
我们已表明，旨在改善我们中心卒中溶栓治疗的QI项目能够以相对较低的成本实施并维持，且随着时间推移成本效益不断提高。我们的工作建立在QI项目和基于模拟的培训中经济评估的新兴理论和实践基础之上。所呈现的成本效益数据可能有助于指导医疗保健领导者规划类似干预措施。
