Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life

J. Wardlaw, J Seymour, John Alexander Cairns, S. Keir, S. Lewis, P. Sandercock

    Research output: Contribution to journalArticle

    77 Citations (Scopus)

    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 pound10 279 728 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (pound9 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" (pound12 592 666 and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (pound10 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.

    Original languageEnglish
    Pages (from-to)2477-2484
    Number of pages7
    JournalStroke
    Volume35
    DOIs
    Publication statusPublished - 2004

    Keywords

    • cerebrovascular disorders
    • computed tomography
    • cost-benefit analysis
    • decision analysis
    • intracerebral hemorrhage
    • stroke
    • INTRACEREBRAL HEMORRHAGE
    • INTRACRANIAL HEMORRHAGE
    • ANTIPLATELET THERAPY
    • ISCHEMIC-STROKE
    • INFARCTION
    • BRAIN
    • METAANALYSIS
    • DIAGNOSIS
    • ACCURACY
    • ASPIRIN

    Cite this

    Wardlaw, J., Seymour, J., Cairns, J. A., Keir, S., Lewis, S., & Sandercock, P. (2004). Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life. Stroke, 35, 2477-2484. https://doi.org/10.1161/01.STR.0000143453.78005.44

    Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life. / Wardlaw, J.; Seymour, J; Cairns, John Alexander; Keir, S.; Lewis, S.; Sandercock, P.

    In: Stroke, Vol. 35, 2004, p. 2477-2484.

    Research output: Contribution to journalArticle

    Wardlaw, J, Seymour, J, Cairns, JA, Keir, S, Lewis, S & Sandercock, P 2004, 'Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life', Stroke, vol. 35, pp. 2477-2484. https://doi.org/10.1161/01.STR.0000143453.78005.44
    Wardlaw, J. ; Seymour, J ; Cairns, John Alexander ; Keir, S. ; Lewis, S. ; Sandercock, P. / Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life. In: Stroke. 2004 ; Vol. 35. pp. 2477-2484.
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    T1 - Immediate computed tomography scanning of acute stroke is cost-effective and improves quality of life

    AU - Wardlaw, J.

    AU - Seymour, J

    AU - Cairns, John Alexander

    AU - Keir, S.

    AU - Lewis, S.

    AU - Sandercock, P.

    PY - 2004

    Y1 - 2004

    N2 - 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 pound10 279 728 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (pound9 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" (pound12 592 666 and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (pound10 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.

    AB - 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 pound10 279 728 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (pound9 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" (pound12 592 666 and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (pound10 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.

    KW - cerebrovascular disorders

    KW - computed tomography

    KW - cost-benefit analysis

    KW - decision analysis

    KW - intracerebral hemorrhage

    KW - stroke

    KW - INTRACEREBRAL HEMORRHAGE

    KW - INTRACRANIAL HEMORRHAGE

    KW - ANTIPLATELET THERAPY

    KW - ISCHEMIC-STROKE

    KW - INFARCTION

    KW - BRAIN

    KW - METAANALYSIS

    KW - DIAGNOSIS

    KW - ACCURACY

    KW - ASPIRIN

    U2 - 10.1161/01.STR.0000143453.78005.44

    DO - 10.1161/01.STR.0000143453.78005.44

    M3 - Article

    VL - 35

    SP - 2477

    EP - 2484

    JO - Stroke

    JF - Stroke

    SN - 0039-2499

    ER -