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(Stroke. 1998;29:351-358.)
© 1998 American Heart Association, Inc.

Original Contributions

Comparison of the Use of Medical Resources and Outcomes in the Treatment of Aneurysmal Subarachnoid Hemorrhage Between Canada and the United States

Henry A. Glick, MA; Daniel Polsky, PhD; Richard J. Willke, PhD; Wayne M. Alves, PhD; Neal Kassell, MD; Kevin Schulman, MD

From the Division of General Internal Medicine and the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (H.G., D.P.); Pharmacia and Upjohn Inc., Kalamazoo, Mich (R.W.); the Department of Neurosurgery and the Virginia Neurological Institute, University of Virginia, Charlottesville, Va (W.A., N.K.); and the Clinical Economics Research Unit, Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC (K.S.).

E-mail hlthsvrs{at}mail.med.upenn.edu

Objective—Using data from a randomized trial of tirilazad mesylate, we assessed the differences between Canada and the United States in the use of medical resources and outcomes in the treatment of aneurysmal subarachnoid hemorrhage during the first 90 days after admission to the hospital.

Methods—Of the 877 patients for whom economic data were available, 194 were enrolled in Canada and 683 were enrolled in the United States. The differences between the countries in patient characteristics, use of medical resources, and outcomes were analyzed by comparing means and the 95% confidence intervals (CIs) around the differences in means. These differences also were predicted with use of multivariable regression analysis.

Results—The average hospital stay was 4.2 days longer (95% CI, 1.3 to 7.1 days) in Canada, but most of the extra stay was among patients admitted to the study in poor neurological condition. In general, however, hospital stays in Canada were substantially less intensive. Patients treated in Canada spent 3.7 fewer days (95% CI, 1.2 to 6.1 days) in nursing homes and rehabilitation centers than did patients in the United States. No statistically significant differences were seen for Glasgow Outcome Scale score, death, and occurrence of vasospasm.

Conclusions—For patients admitted to the study in good neurological condition, the apparent difference in length of stay between Canada and the United States was caused by a shift in the sites of formal care rather than to the length of this care. For those admitted in poor neurological condition, both the length and sites of care differed between the two countries. No significant difference in outcomes appeared to justify these differences in the use of medical resources.

Key Words: Canada • lipid peroxidation • subarachnoid hemorrhage

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