London, United Kingdom 2013 Poster Session Red Cerebrovasc Dis 2013; 35 (suppl 3)1-854 473 353 Management and economics The non-admission based Monash Transient Ischaemic Attack (TIA) Triaging Treatment (M3T) model of care is cost-effective compared with routine hospital admission for TIA L.M. Sanders1, D.A. Cadilhac2, V.K. Srikanth3, C.P. Chong4, T.G. Phan5 Stroke & Ageing Research Centre, Monash University, Clayton, AUSTRALIA1, Stroke & Age-ing Research Centre, Monash University, Clayton, AUSTRALIA2, Stroke & Ageing Research Cen-tre, Monash University, Clayton, AUSTRALIA3, Stroke & Ageing Research Centre, Monash Uni-versity, Clayton, AUSTRALIA4, Stroke & Ageing Research Centre, Monash University, Clayton, AUSTRALIA5 Background: Rapid non-admission based management of Transient Ischaemic Attack (TIA) effec-tively reduces stroke risk and may be cost-effective compared with admission-based (inpatient) care. We have previously established the safety of the Monash TIA Triaging Treatment (M3T) non-admis-sion based model compared with routine admission with respect to 90-day stroke recurrence. In this study, we assess the cost-effectiveness of M3T with that of the previous admission-based model. Methods: Pre-post, micro-costing cohort design. Cost data for each patient for all hospital presen-tations, investigations and clinic appointments associated with M3T (2004-2007) and the previous admission-based model (2003) were collected. Primary outcome: difference in average episode costs per patient. Multivariable uncertainty analyses were performed by varying hospital bed and clinic costs over 10,000 Monte Carlo simulations. Costs are presented in 2012 Australian dollars (AUD). Incremental cost-effectiveness for strokes averted per 100 patients was estimated and uncertainty as-sessed by varying hospital admission rates, length of stay, and number of investigations. Results: The average cost per episode was less for M3T (AUD1927.38 95% confidence interval CI AUD1827.80-AUD2036.92) compared with the admission-based model (AUD4841.49 95% CI AUD4178.40-AUD5590.03). The annual clinic costs were double in M3T compared with the admis-sion- based model, but this was offset by the reduction in hospital bed-day costs of the former model. Recurrent stroke at 90 days in M3T was 1.50% (95% CI 0.73%-3.05%) compared with 4.67% (95% CI 2.28%-9.32%) in the admission-based model. Cost-effectiveness analyses demonstrated that M3T was cost-saving with respect to the number of strokes averted per 100 patients treated. Conclusion: The non-admission based M3T model of TIA care is cost-saving in preventing stroke within 90 days when compared with routine hospital admission. 354 Management and economics Changes in acute hospital costs for stroke after clinical facilitators employed to improve stroke care: an Australian case study. D.A. Cadilhac1, H.M. Dewey2, A. Meretoja3 Translational Public Health Unit, Stroke & Ageing Research Centre, Southern Clinical School, Monash University, Melbourne, AUSTRALIA1, Department of Neurology, Austin Health, Mel-bourne, AUSTRALIA2, Stoke Division, The Florey Institute of Neuroscience and Mental Health, Melbourne, AUSTRALIA3 Background: Understanding trends in resource use within hospitals is important since the most expensive costs related to stroke in the first year are from hospitalisation. In 2007, the Victorian Government in Australia selected eight hospitals to employ clinical facilitators for three years to establish stroke units and protocols to improve stroke care. It is unclear if inpatient costs changed over this period. We aimed to describe the costs of acute care before and after the implementation of stroke care initiatives. Methods: Pre (financial year FY 2006-07) and post (FY 2010-11) cohort design of all admitted ep-isodes of stroke or Transient Ischemic Attack (TIA) using ICD-10 discharge codes (I61, I63, G45). Patient-level clinical costing data was provided by the Victorian Department of Health. Generalised linear regression models were used to compare FYs. Results: Data on 4827 episodes, 2125 pre (age >75 years 52%) and 2702 post (age >75 years 50%) showed a 27% increase in episodes managed at the selected hospitals; half explained by more TIA admissions (39% increase since 2006-07). Overall, average length of stay (LOS) reduced by 20% (mean 8.3 days pre to 6.6 days post). Six hospitals provided cost data with AUD10.4 million spent in the care of stroke patients in 2006-7, and AUD13.7 million in 2010-11, a 32.4% increase in the setting of 8% health cost inflation. After adjusting for patient age, gender, stroke subtype, and hos-pital there was a 1.1% increase in mean per-episode costs between 2006 and 2010 (AUD7303 pre; AUD7386 post, p=0.70). When LOS was additionally adjusted for, these costs increased by 21% re-flecting a change in the mean cost per day. Conclusion: Cost containment for the mean cost per acute inpatient episode was observed after the implementation of stroke care initiatives despite increasing numbers of episodes and shorter lengths of stay. Future research should assess costs across the whole chain of recovery to better inform health policy.
Karger_ESC London_2013
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