Observed Cost and Variations in Short Term Cost‐Effectiveness of Therapy for Ischemic Stroke in Interventional Management of Stroke (IMS) III
Identifieur interne : 000701 ( Main/Exploration ); précédent : 000700; suivant : 000702Observed Cost and Variations in Short Term Cost‐Effectiveness of Therapy for Ischemic Stroke in Interventional Management of Stroke (IMS) III
Auteurs : Kit N. Simpson ; Annie N. Simpson ; Patrick D. Mauldin ; Yuko Y. Palesch ; Sharon D. Yeatts ; Dawn Kleindorfer ; Thomas A. Tomsick ; Lydia D. Foster ; Andrew M. Demchuk ; Pooja Khatri ; Michael D. Hill ; Edward C. Jauch ; Tudor G. Jovin ; Bernard Yan ; Rüdiger Von Kummer ; Carlos A. Molina ; Mayank Goyal ; Wouter J. Schonewille ; Mikael Mazighi ; Stefan T. Engelter ; Craig Anderson ; Judith Spilker ; Janice Carrozzella ; Karla J. Ryckborst ; L. Scott Janis ; Joseph P. BroderickSource :
- Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease [ 2047-9980 ] ; 2017.
Abstract
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)
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
Url:
DOI: 10.1161/JAHA.116.004513
PubMed: 28483774
PubMed Central: 5524059
Affiliations:
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Ryckborst</name><affiliation><nlm:aff id="jah32232-aff-0006"></nlm:aff></affiliation></author><author><name sortKey="Janis, L Scott" sort="Janis, L Scott" uniqKey="Janis L" first="L. Scott" last="Janis">L. Scott Janis</name><affiliation><nlm:aff id="jah32232-aff-0017"></nlm:aff></affiliation></author><author><name sortKey="Broderick, Joseph P" sort="Broderick, Joseph P" uniqKey="Broderick J" first="Joseph P." last="Broderick">Joseph P. 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Simpson</name><affiliation><nlm:aff id="jah32232-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Simpson, Annie N" sort="Simpson, Annie N" uniqKey="Simpson A" first="Annie N." last="Simpson">Annie N. Simpson</name><affiliation><nlm:aff id="jah32232-aff-0002"></nlm:aff></affiliation></author><author><name sortKey="Mauldin, Patrick D" sort="Mauldin, Patrick D" uniqKey="Mauldin P" first="Patrick D." last="Mauldin">Patrick D. Mauldin</name><affiliation><nlm:aff id="jah32232-aff-0004"></nlm:aff></affiliation></author><author><name sortKey="Palesch, Yuko Y" sort="Palesch, Yuko Y" uniqKey="Palesch Y" first="Yuko Y." last="Palesch">Yuko Y. Palesch</name><affiliation><nlm:aff id="jah32232-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Yeatts, Sharon D" sort="Yeatts, Sharon D" uniqKey="Yeatts S" first="Sharon D." last="Yeatts">Sharon D. Yeatts</name><affiliation><nlm:aff id="jah32232-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Kleindorfer, Dawn" sort="Kleindorfer, Dawn" uniqKey="Kleindorfer D" first="Dawn" last="Kleindorfer">Dawn Kleindorfer</name><affiliation><nlm:aff id="jah32232-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Tomsick, Thomas A" sort="Tomsick, Thomas A" uniqKey="Tomsick T" first="Thomas A." last="Tomsick">Thomas A. Tomsick</name><affiliation><nlm:aff id="jah32232-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Foster, Lydia D" sort="Foster, Lydia D" uniqKey="Foster L" first="Lydia D." last="Foster">Lydia D. Foster</name><affiliation><nlm:aff id="jah32232-aff-0003"></nlm:aff></affiliation></author><author><name sortKey="Demchuk, Andrew M" sort="Demchuk, Andrew M" uniqKey="Demchuk A" first="Andrew M." last="Demchuk">Andrew M. Demchuk</name><affiliation><nlm:aff id="jah32232-aff-0006"></nlm:aff></affiliation></author><author><name sortKey="Khatri, Pooja" sort="Khatri, Pooja" uniqKey="Khatri P" first="Pooja" last="Khatri">Pooja Khatri</name><affiliation><nlm:aff id="jah32232-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Hill, Michael D" sort="Hill, Michael D" uniqKey="Hill M" first="Michael D." last="Hill">Michael D. Hill</name><affiliation><nlm:aff id="jah32232-aff-0006"></nlm:aff></affiliation></author><author><name sortKey="Jauch, Edward C" sort="Jauch, Edward C" uniqKey="Jauch E" first="Edward C." last="Jauch">Edward C. Jauch</name><affiliation><nlm:aff id="jah32232-aff-0005"></nlm:aff></affiliation></author><author><name sortKey="Jovin, Tudor G" sort="Jovin, Tudor G" uniqKey="Jovin T" first="Tudor G." last="Jovin">Tudor G. Jovin</name><affiliation><nlm:aff id="jah32232-aff-0007"></nlm:aff></affiliation></author><author><name sortKey="Yan, Bernard" sort="Yan, Bernard" uniqKey="Yan B" first="Bernard" last="Yan">Bernard Yan</name><affiliation><nlm:aff id="jah32232-aff-0008"></nlm:aff></affiliation></author><author><name sortKey="Von Kummer, Rudiger" sort="Von Kummer, Rudiger" uniqKey="Von Kummer R" first="Rüdiger" last="Von Kummer">Rüdiger Von Kummer</name><affiliation><nlm:aff id="jah32232-aff-0009"></nlm:aff></affiliation></author><author><name sortKey="Molina, Carlos A" sort="Molina, Carlos A" uniqKey="Molina C" first="Carlos A." last="Molina">Carlos A. Molina</name><affiliation><nlm:aff id="jah32232-aff-0010"></nlm:aff></affiliation></author><author><name sortKey="Goyal, Mayank" sort="Goyal, Mayank" uniqKey="Goyal M" first="Mayank" last="Goyal">Mayank Goyal</name><affiliation><nlm:aff id="jah32232-aff-0006"></nlm:aff></affiliation></author><author><name sortKey="Schonewille, Wouter J" sort="Schonewille, Wouter J" uniqKey="Schonewille W" first="Wouter J." last="Schonewille">Wouter J. Schonewille</name><affiliation><nlm:aff id="jah32232-aff-0011"></nlm:aff></affiliation><affiliation><nlm:aff id="jah32232-aff-0012"></nlm:aff></affiliation></author><author><name sortKey="Mazighi, Mikael" sort="Mazighi, Mikael" uniqKey="Mazighi M" first="Mikael" last="Mazighi">Mikael Mazighi</name><affiliation><nlm:aff id="jah32232-aff-0013"></nlm:aff></affiliation></author><author><name sortKey="Engelter, Stefan T" sort="Engelter, Stefan T" uniqKey="Engelter S" first="Stefan T." last="Engelter">Stefan T. Engelter</name><affiliation><nlm:aff id="jah32232-aff-0014"></nlm:aff></affiliation><affiliation><nlm:aff id="jah32232-aff-0015"></nlm:aff></affiliation></author><author><name sortKey="Anderson, Craig" sort="Anderson, Craig" uniqKey="Anderson C" first="Craig" last="Anderson">Craig Anderson</name><affiliation><nlm:aff id="jah32232-aff-0016"></nlm:aff></affiliation></author><author><name sortKey="Spilker, Judith" sort="Spilker, Judith" uniqKey="Spilker J" first="Judith" last="Spilker">Judith Spilker</name><affiliation><nlm:aff id="jah32232-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Carrozzella, Janice" sort="Carrozzella, Janice" uniqKey="Carrozzella J" first="Janice" last="Carrozzella">Janice Carrozzella</name><affiliation><nlm:aff id="jah32232-aff-0001"></nlm:aff></affiliation></author><author><name sortKey="Ryckborst, Karla J" sort="Ryckborst, Karla J" uniqKey="Ryckborst K" first="Karla J." last="Ryckborst">Karla J. Ryckborst</name><affiliation><nlm:aff id="jah32232-aff-0006"></nlm:aff></affiliation></author><author><name sortKey="Janis, L Scott" sort="Janis, L Scott" uniqKey="Janis L" first="L. Scott" last="Janis">L. Scott Janis</name><affiliation><nlm:aff id="jah32232-aff-0017"></nlm:aff></affiliation></author><author><name sortKey="Broderick, Joseph P" sort="Broderick, Joseph P" uniqKey="Broderick J" first="Joseph P." last="Broderick">Joseph P. Broderick</name><affiliation><nlm:aff id="jah32232-aff-0001"></nlm:aff></affiliation></author></analytic><series><title level="j">Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease</title><idno type="eISSN">2047-9980</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="jah32232-sec-0001"><title>Background</title><p>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) <styled-content style="fixed-case">III</styled-content> Trial.</p></sec><sec id="jah32232-sec-0002"><title>Methods and Results</title><p>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).</p></sec><sec id="jah32232-sec-0003"><title>Conclusions</title><p>Detailed economic and resource utilization data from <styled-content style="fixed-case">IMS III</styled-content> 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.</p></sec><sec id="jah32232-sec-0004"><title>Clinical Trial Registration</title><p><styled-content style="fixed-case">URL</styled-content>: <ext-link ext-link-type="uri" xlink:href="http://www.clinicaltrials.gov">http://www.clinicaltrials.gov</ext-link>. Registration number: <styled-content style="fixed-case">NCT</styled-content>00359424.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct></listBibl></div1></back></TEI><affiliations><list></list><tree><noCountry><name sortKey="Anderson, Craig" sort="Anderson, Craig" uniqKey="Anderson C" first="Craig" last="Anderson">Craig Anderson</name><name sortKey="Broderick, Joseph P" sort="Broderick, Joseph P" uniqKey="Broderick J" first="Joseph P." last="Broderick">Joseph P. Broderick</name><name sortKey="Carrozzella, Janice" sort="Carrozzella, Janice" uniqKey="Carrozzella J" first="Janice" last="Carrozzella">Janice Carrozzella</name><name sortKey="Demchuk, Andrew M" sort="Demchuk, Andrew M" uniqKey="Demchuk A" first="Andrew M." last="Demchuk">Andrew M. Demchuk</name><name sortKey="Engelter, Stefan T" sort="Engelter, Stefan T" uniqKey="Engelter S" first="Stefan T." last="Engelter">Stefan T. Engelter</name><name sortKey="Foster, Lydia D" sort="Foster, Lydia D" uniqKey="Foster L" first="Lydia D." last="Foster">Lydia D. Foster</name><name sortKey="Goyal, Mayank" sort="Goyal, Mayank" uniqKey="Goyal M" first="Mayank" last="Goyal">Mayank Goyal</name><name sortKey="Hill, Michael D" sort="Hill, Michael D" uniqKey="Hill M" first="Michael D." last="Hill">Michael D. Hill</name><name sortKey="Janis, L Scott" sort="Janis, L Scott" uniqKey="Janis L" first="L. Scott" last="Janis">L. Scott Janis</name><name sortKey="Jauch, Edward C" sort="Jauch, Edward C" uniqKey="Jauch E" first="Edward C." last="Jauch">Edward C. Jauch</name><name sortKey="Jovin, Tudor G" sort="Jovin, Tudor G" uniqKey="Jovin T" first="Tudor G." last="Jovin">Tudor G. Jovin</name><name sortKey="Khatri, Pooja" sort="Khatri, Pooja" uniqKey="Khatri P" first="Pooja" last="Khatri">Pooja Khatri</name><name sortKey="Kleindorfer, Dawn" sort="Kleindorfer, Dawn" uniqKey="Kleindorfer D" first="Dawn" last="Kleindorfer">Dawn Kleindorfer</name><name sortKey="Mauldin, Patrick D" sort="Mauldin, Patrick D" uniqKey="Mauldin P" first="Patrick D." last="Mauldin">Patrick D. Mauldin</name><name sortKey="Mazighi, Mikael" sort="Mazighi, Mikael" uniqKey="Mazighi M" first="Mikael" last="Mazighi">Mikael Mazighi</name><name sortKey="Molina, Carlos A" sort="Molina, Carlos A" uniqKey="Molina C" first="Carlos A." last="Molina">Carlos A. Molina</name><name sortKey="Palesch, Yuko Y" sort="Palesch, Yuko Y" uniqKey="Palesch Y" first="Yuko Y." last="Palesch">Yuko Y. Palesch</name><name sortKey="Ryckborst, Karla J" sort="Ryckborst, Karla J" uniqKey="Ryckborst K" first="Karla J." last="Ryckborst">Karla J. Ryckborst</name><name sortKey="Schonewille, Wouter J" sort="Schonewille, Wouter J" uniqKey="Schonewille W" first="Wouter J." last="Schonewille">Wouter J. Schonewille</name><name sortKey="Simpson, Annie N" sort="Simpson, Annie N" uniqKey="Simpson A" first="Annie N." last="Simpson">Annie N. Simpson</name><name sortKey="Simpson, Kit N" sort="Simpson, Kit N" uniqKey="Simpson K" first="Kit N." last="Simpson">Kit N. Simpson</name><name sortKey="Spilker, Judith" sort="Spilker, Judith" uniqKey="Spilker J" first="Judith" last="Spilker">Judith Spilker</name><name sortKey="Tomsick, Thomas A" sort="Tomsick, Thomas A" uniqKey="Tomsick T" first="Thomas A." last="Tomsick">Thomas A. Tomsick</name><name sortKey="Von Kummer, Rudiger" sort="Von Kummer, Rudiger" uniqKey="Von Kummer R" first="Rüdiger" last="Von Kummer">Rüdiger Von Kummer</name><name sortKey="Yan, Bernard" sort="Yan, Bernard" uniqKey="Yan B" first="Bernard" last="Yan">Bernard Yan</name><name sortKey="Yeatts, Sharon D" sort="Yeatts, Sharon D" uniqKey="Yeatts S" first="Sharon D." last="Yeatts">Sharon D. Yeatts</name></noCountry></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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HfdIndexSelect -h $EXPLOR_AREA/Data/Main/Exploration/RBID.i -Sk "pubmed:28483774" \
| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \
| NlmPubMed2Wicri -a AustralieFrV1
| This area was generated with Dilib version V0.6.33. |  |