Published Online
on September 30, 2004

A more recent version of this article appeared on November 1, 2004

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Submitted on May 3, 2004
Revised on July 10, 2004
Accepted on July 19, 2004

Immediate Computed Tomography Scanning of Acute Stroke Is Cost-Effective and Improves Quality of Life

Joanna M. Wardlaw FRCP, FRCR, MD^*; Janelle Seymour; John Cairns; Sarah Keir MD, MRCP; Steff Lewis PhD; and Peter Sandercock FRCP, MD

From the Division of Clinical Neurosciences (J.M.W., S.K., S.L., P.S.), Western General Hospital, Edinburgh, UK; and the Health Economics Research Unit (J.S., J.C.), University of Aberdeen, Foresterhill Hospital, Aberdeen, UK.

^* To whom correspondence should be addressed. E-mail: jmw{at}skull.dcn.ed.ac.uk.

Background and Purpose--Stroke is very common, but computed tomography (CT) scanning, an expensive and finite resource, is required to differentiate cerebral infarction, hemorrhage, and stroke mimics. We determined whether, and in what circumstances, CT is cost-effective in acute stroke.

Methods--We developed a decision tree representing acute stroke care pathways populated with data from multiple sources. We determined the effect of diagnostic information from CT scanning on functional outcome, length of stay, costs, and quality of life during 5 years for 13 alternative CT strategies (varying proportions and types of patients and rapidity of scanning).

Results--For 1000 patients aged 70 to 74 years, the policy "scan all strokes within 48 hours" cost £10 279 728 and achieved 1982.3 quality-adjusted life years (QALYs). The most cost-effective strategy was "scan all immediately" (£9 993 676 and 1982.4 QALYs). The least cost-effective was "scan patients on anticoagulants and those in a life-threatening condition immediately and the rest within 14 days" (£12 592 666 and 1931.8 QALYs). "Scan no patients" reduced QALYs (1904.2) and increased cost (£10 544 000).

Conclusion--Immediate CT scanning is the most cost-effective strategy. For the majority of acute stroke patients, increasing independent survival by correct early diagnosis, ensuring appropriate subsequent treatment and management decisions, reduced costs of stroke and increased QALYs.

Key words: cerebrovascular disorders • computed tomography • cost-benefit analysis • decision analysis • intracerebral hemorrhage • stroke

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