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: A...
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| Format: | Article |
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Frontiers Media S.A.
2021-11-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.774657/full |
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| author | Artem T. Boltyenkov Artem T. Boltyenkov Artem T. Boltyenkov Gabriela Martinez Gabriela Martinez Gabriela Martinez Ankur Pandya Jeffrey M. Katz Jeffrey M. Katz Jason J. Wang Jason J. Naidich Jason J. Naidich Elizabeth Rula Pina C. Sanelli Pina C. Sanelli |
| author_facet | Artem T. Boltyenkov Artem T. Boltyenkov Artem T. Boltyenkov Gabriela Martinez Gabriela Martinez Gabriela Martinez Ankur Pandya Jeffrey M. Katz Jeffrey M. Katz Jason J. Wang Jason J. Naidich Jason J. Naidich Elizabeth Rula Pina C. Sanelli Pina C. Sanelli |
| author_sort | Artem T. Boltyenkov |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-21T04:11:47Z |
| format | Article |
| id | doaj.art-b70718b4d5294faba8628caac9878329 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-21T04:11:47Z |
| publishDate | 2021-11-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Neurology |
| spelling | doaj.art-b70718b4d5294faba8628caac98783292022-12-21T19:16:26ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-11-011210.3389/fneur.2021.774657774657Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke CareArtem T. Boltyenkov0Artem T. Boltyenkov1Artem T. Boltyenkov2Gabriela Martinez3Gabriela Martinez4Gabriela Martinez5Ankur Pandya6Jeffrey M. Katz7Jeffrey M. Katz8Jason J. Wang9Jason J. Naidich10Jason J. Naidich11Elizabeth Rula12Pina C. Sanelli13Pina C. Sanelli14Center for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY, United StatesSiemens Healthcare, Malvern, PA, United StatesDepartment of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United StatesCenter for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY, United StatesSiemens Healthcare, Malvern, PA, United StatesDepartment of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United StatesDepartment of Health Policy and Management, School of Public Health, Harvard University, Boston, MA, United StatesDepartment of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United StatesDepartment of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United StatesCenter for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY, United StatesCenter for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY, United StatesDepartment of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United StatesHarvey L. Neiman Health Policy Institute, Reston, VA, United StatesCenter for Health Innovations and Outcomes Research, Feinstein Institute for Medical Research, Manhasset, NY, United StatesDepartment of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra-Northwell, Hempstead, NY, United StatesIntroduction: 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.https://www.frontiersin.org/articles/10.3389/fneur.2021.774657/fullcost-consequence analysisacute ischemic strokecomputerized tomography (CT)angiographyperfusion |
| spellingShingle | Artem T. Boltyenkov Artem T. Boltyenkov Artem T. Boltyenkov Gabriela Martinez Gabriela Martinez Gabriela Martinez Ankur Pandya Jeffrey M. Katz Jeffrey M. Katz Jason J. Wang Jason J. Naidich Jason J. Naidich Elizabeth Rula Pina C. Sanelli Pina C. Sanelli Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care Frontiers in Neurology cost-consequence analysis acute ischemic stroke computerized tomography (CT) angiography perfusion |
| 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 | cost-consequence analysis acute ischemic stroke computerized tomography (CT) angiography perfusion |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.774657/full |
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