Transferring Stroke Patient to Neuro ICU is Cost Effective

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Transferring a stroke patient with intracerebral hemorrhage to a hospital with a dedicated neurological intensive care unit (ICU) is cost effective even if the transfer only results in a modest improvement in the functional outcome, according to a study published in Stroke.

Still, there isn’t enough data to definitively say that treatment in neuro ICUs results in better functional outcomes. A patient that is transferred to a neuro ICU that survives but with severe disabilities would be the least cost effective outcome.

Jeffrey J. Fletcher, MD, of the University of Michigan at Ann Arbor, and colleagues measured the effect of neuro ICU care on functional outcomes in three scenarios: a favorable outcome based on observational data that suggested a small and consistent improvement in functionality, a moderately favorable outcome and a least favorable outcome, in which survivors were severely disabled requiring constant care. Health benefits were measured in quality-adjusted life years (QALYs) and cost was combined with QALYs to create cost-effectiveness ratios.

Transfer to a neuro ICU increased QALYs across all scenarios; however the effect was modest in the least favorable outcome. Transfer to a neuro ICU had a cost-effectiveness ratio of $47,431 per QALY in favorable outcomes, $91,674 per QALY in moderately favorable outcomes, and $380,358 per QALY in least favorable outcomes.

With a willingness to pay threshold of $100,000 per QALY, 95% of favorable, 75% of moderately favorable, and 2.1% of least favorable scenarios came in below the threshold. 

stroke with hemorrhage
Transferring Stroke Patient to Neuro ICU is Cost Effective

Specialized neurological intensive care units (neuro-ICUs) with neurocritical care expertise are associated with lower mortality and improved functional outcome in spontaneous intracerebral hemorrhage (ICH). Given that randomized controlled trials have failed to identify interventions that improve outcome after ICH, and that a majority of patients with ICH are not treated in specialized centers, increasing use of hospital-based care in specialized neuro-ICUs may represent an alternative opportunity to improve ICH outcomes.

Jeffrey J. Fletcher, MD, of the University of Michigan at Ann Arbor, and colleagues aimed to estimate the cost-effectiveness of transferring patients with intracerebral hemorrhage from centers without specialized neurological intensive care units (neuro-ICUs) to centers with neuro-ICUs.

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