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Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care

Introduction: The purpose of this study was to illustrate the potential costs and health consequences of implementing advanced CT angiography and perfusion (CTAP) as the initial imaging in patients presenting with acute ischemic stroke (AIS) symptoms at a comprehensive stroke center (CSC). Methods:...

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Autores principales: Boltyenkov, Artem T., Martinez, Gabriela, Pandya, Ankur, Katz, Jeffrey M., Wang, Jason J., Naidich, Jason J., Rula, Elizabeth, Sanelli, Pina C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662622/
https://www.ncbi.nlm.nih.gov/pubmed/34899583
http://dx.doi.org/10.3389/fneur.2021.774657
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author Boltyenkov, Artem T.
Martinez, Gabriela
Pandya, Ankur
Katz, Jeffrey M.
Wang, Jason J.
Naidich, Jason J.
Rula, Elizabeth
Sanelli, Pina C.
author_facet Boltyenkov, Artem T.
Martinez, Gabriela
Pandya, Ankur
Katz, Jeffrey M.
Wang, Jason J.
Naidich, Jason J.
Rula, Elizabeth
Sanelli, Pina C.
author_sort Boltyenkov, Artem T.
collection PubMed
description Introduction: The purpose of this study was to illustrate the potential costs and health consequences of implementing advanced CT angiography and perfusion (CTAP) as the initial imaging in patients presenting with acute ischemic stroke (AIS) symptoms at a comprehensive stroke center (CSC). Methods: A decision-simulation model based on the American Heart Association's recommendations for AIS care pathways was developed to assess imaging strategies for a 5-year period from the institutional perspective. The following strategies were compared: (1) advanced CTAP imaging: NCCT + CTA + CT perfusion at the time of presentation; (2) standard-of-care: non-contrast CT (NCCT) at the time of presentation, with CT angiography (CTA) ± CT perfusion only in select patients (initial imaging to exclude hemorrhage and extensive ischemia) for mechanical thrombectomy (MT) evaluation. Model parameters were defined with evidence-based data. Cost-consequence and sensitivity analyses were performed. The modified Rankin Scale (mRS) at 90 days was used as the outcome measure. Results: The decision-simulation modeling revealed that adoption of the advanced CTAP imaging increased per-patient imaging costs by 1.19% ($9.28/$779.72), increased per-patient treatment costs by 33.25% ($729.96/$2,195.24), and decreased other per-patient acute care costs by 0.7% (–$114.12/$16,285.85). The large increase in treatment costs was caused by higher proportion of patients being treated. However, improved outcomes lowered the other per-patient acute care costs. Over the five-year period, advanced CTAP imaging led to 1.63% (66/4,040) more patients with good outcomes (90-day mRS 0-2), 2.23% (66/2,960) fewer patients with poor outcomes (90-day mRS 3-5), and no change in mortality (90-day mRS 6). Our CT equipment utilization analysis showed that the demand for CT equipment in terms of scanner time (minutes) was 24% lower in the advanced CTAP imaging strategy compared to the standard-of-care strategy. The number of EVT procedures performed at the CSC may increase by 50%. Conclusions: Our study reveals that adoption of advanced CTAP imaging at presentation increases the demand for treatment of acute ischemic stroke patients as more patients are diagnosed within the treatment time window compared to standard-of-care imaging. Advanced imaging also leads to more patients with good functional outcomes and fewer patients with dependent functional status.
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spelling pubmed-86626222021-12-11 Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care Boltyenkov, Artem T. Martinez, Gabriela Pandya, Ankur Katz, Jeffrey M. Wang, Jason J. Naidich, Jason J. Rula, Elizabeth Sanelli, Pina C. Front Neurol Neurology Introduction: The purpose of this study was to illustrate the potential costs and health consequences of implementing advanced CT angiography and perfusion (CTAP) as the initial imaging in patients presenting with acute ischemic stroke (AIS) symptoms at a comprehensive stroke center (CSC). Methods: A decision-simulation model based on the American Heart Association's recommendations for AIS care pathways was developed to assess imaging strategies for a 5-year period from the institutional perspective. The following strategies were compared: (1) advanced CTAP imaging: NCCT + CTA + CT perfusion at the time of presentation; (2) standard-of-care: non-contrast CT (NCCT) at the time of presentation, with CT angiography (CTA) ± CT perfusion only in select patients (initial imaging to exclude hemorrhage and extensive ischemia) for mechanical thrombectomy (MT) evaluation. Model parameters were defined with evidence-based data. Cost-consequence and sensitivity analyses were performed. The modified Rankin Scale (mRS) at 90 days was used as the outcome measure. Results: The decision-simulation modeling revealed that adoption of the advanced CTAP imaging increased per-patient imaging costs by 1.19% ($9.28/$779.72), increased per-patient treatment costs by 33.25% ($729.96/$2,195.24), and decreased other per-patient acute care costs by 0.7% (–$114.12/$16,285.85). The large increase in treatment costs was caused by higher proportion of patients being treated. However, improved outcomes lowered the other per-patient acute care costs. Over the five-year period, advanced CTAP imaging led to 1.63% (66/4,040) more patients with good outcomes (90-day mRS 0-2), 2.23% (66/2,960) fewer patients with poor outcomes (90-day mRS 3-5), and no change in mortality (90-day mRS 6). Our CT equipment utilization analysis showed that the demand for CT equipment in terms of scanner time (minutes) was 24% lower in the advanced CTAP imaging strategy compared to the standard-of-care strategy. The number of EVT procedures performed at the CSC may increase by 50%. Conclusions: Our study reveals that adoption of advanced CTAP imaging at presentation increases the demand for treatment of acute ischemic stroke patients as more patients are diagnosed within the treatment time window compared to standard-of-care imaging. Advanced imaging also leads to more patients with good functional outcomes and fewer patients with dependent functional status. Frontiers Media S.A. 2021-11-26 /pmc/articles/PMC8662622/ /pubmed/34899583 http://dx.doi.org/10.3389/fneur.2021.774657 Text en Copyright © 2021 Boltyenkov, Martinez, Pandya, Katz, Wang, Naidich, Rula and Sanelli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Boltyenkov, Artem T.
Martinez, Gabriela
Pandya, Ankur
Katz, Jeffrey M.
Wang, Jason J.
Naidich, Jason J.
Rula, Elizabeth
Sanelli, Pina C.
Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care
title Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care
title_full Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care
title_fullStr Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care
title_full_unstemmed Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care
title_short Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care
title_sort cost-consequence analysis of advanced imaging in acute ischemic stroke care
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8662622/
https://www.ncbi.nlm.nih.gov/pubmed/34899583
http://dx.doi.org/10.3389/fneur.2021.774657
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