Healthcare Resource Utilization in the Three Months after Acute Stroke: A Report on 1604 Patients from the Glycine Antagonist in Neuroprotection (GAIN) Americas Trial
Background/objective: Data on healthcare resource utilization (RU) in acute stroke will assist in evaluation of cost-efficacy and cost-effectiveness of new treatments. We present results of a substudy of resource utilization within GAIN Americas, a multi-center, randomized, placebo-controlled, phase 3 clinical trial of the glycine antagonist GV150526 in acute stroke, conducted in the US and Canada. Previously reported clinical results showed no difference in clinical outcome by treatment at 3 months. Methods: RU data included pre-stroke and Month 3 residence and employment status, hospital length of stay (LOS) by ward type, discharge destination, and outpatient rehabilitation services. There were no treatment differences on RU endpoints, so data were combined across treatment groups. Results: The study population comprised 1604 acute stroke patients (85% ischemic; median age: 72; female: 48%; median NIHSS score: 12). Case fatality was 13% in hospital, 21% by Month 3. Median hospital LOS was 9 days (mean=15), including 3 days (mean = 4.5) in intensive care and 4.5 days (mean=6.8) in step-down. Discharge destinations included rehabilitation facility (49%), home (27%) and nursing home (11%). Pre-stroke, 87% lived in own home, but at 3 months only 62% lived at home. Outpatient rehabilitation services included occupational therapy (31%), physical therapy (39%), speech therapy (20%) and psychotherapy (2%). Pre-stroke, 21% were employed full- or part-time; at Month 3, 6% were employed. Of those employed pre-stroke, 60% reported being unable to work for health reasons at Month 3. Conclusion: These data describe the social and economic burden of stroke in a well-defined cohort. Such information should be valuable to care providers at many levels of the healthcare system and to health outcomes researchers. Prospective collection of detailed RU data from a large clinical trial is feasible and worthwhile.