ECONOMIC BENEFIT OF AN EDUCATIONAL INTERVENTION TO IMPROVE TPA USE IN COMMUNITY HOSPITALS

Purpose:    We analyzed the cost-effectiveness of the INcreasing Stroke Treatment through Interventional Behavior Change Tactics (INSTINCT) trial which targeted emergency physicians with a barrier assessment process and directed educational intervention to increase tissue plasminogen activator (tPA) use for treatment of acute ischemic stroke.

Method:    We examine cost-effectiveness from two perspectives: (1) using the full trial costs (including research overhead) and (2) using the costs associated with the intervention alone (without research related costs such as data monitoring and indirect costs) representing future deployment costs.  Actual cost and tPA use data from the trial were used to determine the immediate impact of the INSTINCT study.  This data was then integrated with a Markov model of longer-term stroke outcomes to examine the overall long-term health and economic impact.

Result:    The direct dollar cost of the INSTINCT trial, plus the opportunity cost of staff education, was (US) $3.29 million.  The model predicted increased tPA use resulting from the intervention would lead to a lifetime healthcare savings of approximately $1.2 million in the treated population.   In addition, the long-term model indicates 210 quality adjusted life-years (QALYs) would be gained.  This indicates a cost-effectiveness ratio of $9,930/QALY gained.  This reflects a net economic value of $8.4 million (conservatively valuing each QALY at $50,000) from the effect of the research trial alone.  Deployment of the intervention de novo in a population of similar size without the associated research overhead would cost approximately $680,000.  The lifetime healthcare cost savings would exceed this amount leading to net long-term cost savings and a net economic value of $11 million using a QALY value of $50,000.

Conclusion:    The INSTINCT trial itself was highly cost effective from a societal viewpoint, creating a net economic benefit of $8.4 million upon study completion.   Future deployment of the intervention has the potential to lead to substantial health benefits and large long-term cost savings.  Further research into efforts to improve tPA use in stroke are economically justified given the large return on investment.