22. European Stroke Conference Trends in the Cost-effectiveness of stroke care - Tables Table 1. Results per year 2006 2007 2008 2009 2010 2011 P-value for 470 © 2013 S. Karger AG, Basel Scientific Programme trend QALY 2.2 2.2 2.2 2.4 2.7 3.1 <0.001 Costs £30,745 £28,939 £28,408 £28,635 £26,933 £27,086 <0.001 Average length of stay (days) 29 28 27 24 19 18 <0.001 Deaths 161 164 165 154 142 123 <0.001 Table 2. Year on Year ICER 2007 vs 2006 2008 vs 2007 2009 vs 2008 2010 vs 2009 2011 vs 2010 ΔQALY 0 0 0.2 0.3 0.4 Δcosts -£1,807 -£531 £ 227 -£1,702 £153 ICER £0 Cost-effective £0 Cost-effective £1,137 Cost-effective 2010 Domina-tes £383 Cost-effective 350 Management and economics Door-to-needle times of tPA administration in acute stroke: the relationship with hospital vol-ume of thrombolysis activity B.D. Bray1, J. Campbell2, G.C. Cloud3, M.A. James4, P. Tyrrell5, C.D.A. Wolfe6, A.G. Rudd7 King’s College London, London, UNITED KINGDOM1, Royal College of Physician’s London, London, UNITED KINGDOM2, St George’s Hospital, London, UNITED KINGDOM3, Royal Dev-on & Exeter Hospital, Exeter, UNITED KINGDOM4, Salford Royal Foundation Trust, Manches-ter, UNITED KINGDOM5, King’s College London, London, UNITED KINGDOM6, Guy’s and St Thomas’ Foundation Trust7 Background Short door-to-needle times of thrombolytic (tPA) therapy in acute stroke is central to its effectiveness.Experience from other conditions suggests that high volume hospitals may achieve better outcomes. We aimed to identify if there was a relationship between the number of patients treated with tPA by hospitals and the door-to-needle times achieved in patients with acute stroke. Methods Data were extracted from the Stroke Improvement National Audit Programme (SINAP) of patients with acute ischaemic stroke admitted to a participating hospital in England from Jan 2011- Aug 2012. Data were linked with the national admissions dataset for England (Hospital Episode Statistics) and only patients from hospitals with >80% case ascertainment in SINAP were included in the analysis. Hospitals were categorised by the annualised number of patients treated with tPA: <50, 50-99 and ≥100 per annum. Median door-to-needle times were compared using Kruskall-Wal-lis tests. Results Of 44 942 patients admitted with acute stroke to 83 hospitals, 4478 (9.1%) received tPA. Median door-to-needle times were significantly shorter in patients admitted to hospitals treat-ing≥ 100 patients per year (41 mins IQR 30-60) compared to those admitted to hospitals treating 50-99 patients (72 mins IQR 51-98) or <50 (73 mins IQR 53-102); time difference 32 minutes , p=0.0001. A similar result was found after categorising hospitals into quintiles of thrombolysis vol-ume, with hospitals in the top quintile of thrombolysis activity achieving a median door-to-needle time of 40 mins (IQR 29-58) compared to 78 mins in the lowest quintile (IQR 60-103); time differ-ence 38 mins, p<0.0001. Conclusions Hospitals treating high volumes of patients with tPA achieved clinically and statistically significant shorter door-to-needle times in this large observational dataset. These findings may have important implications for the planning of stroke services.
Karger_ESC London_2013
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