Abstract 174: Economic Benefit of an Educational Intervention to Improve tPA Use in Community Hospitals: Secondary Analysis of the INSTINCT Trial
Introduction: Prior work demonstrates substantial economic benefit from tPA use. We hypothesized a T2 knowledge translation (KT) program to increase community tPA treatment would provide a cost-effective method to increase tPA use in AIS.
Methods: Data were utilized from the INcreasing Stroke Treatment through INterventional behavior Change Tactics (INSTINCT) trial, a prospective, cluster randomized, controlled trial involving 24 randomly selected acute care community hospitals in matched pairs. Within pairs, hospitals were randomly assigned to receive a barrier assessment-interactive educational intervention (BA-IEI) or no intervention (control). Cost analyses were conducted from a societal perspective for 2 cases: 1) using the total trial research costs and 2) using the intervention costs alone (without research overhead) as an estimate of the costs of generalization of the results. Total trial costs were calculated by combining direct and indirect INSTINCT funding with the opportunity costs of local health professionals attending study events. Savings attributable to increased tPA use were determined by applying published stroke economic data, adjusted for inflation, to the study cohorts. These data were integrated in a Markov model to determine the long-term economic impact of the INSTINCT BA-IEI program versus no intervention.
Results: The total INSTINCT trial cost (US)$3.3 million. In the intervention and post-intervention phases, the intervention sites treated 2.30% (244/10,627) of stroke patients with tPA compared to 1.59% (160/10,071) at control sites (per protocol analysis). This increase in tPA use resulted in a direct medical cost savings of approximately $540,000 due to reduced LOS and use of rehab and nursing facilities in the model. In addition, the increased usage resulted in an estimated additional 81 quality adjusted life years (QALY), with an incremental cost-effectiveness ratio of $34,000/QALY. Using $50,000 as a conservative estimate of societal value per QALY, this provided an additional societal benefit of $4,100,000, or a net economic societal benefit of $1.3 million for the trial. Generalizing the intervention in a similar population (excluding the cost of research overhead) would cost an estimated $680,000 and provide a net economic benefit of $3.9 million, assuming similar intervention effectiveness and treatment outcomes.
Conclusions: Due to the underlying cost-effectiveness of tPA, community knowledge translation efforts which show modest absolute gains in tPA usage demonstrate substantial societal economic returns and are considered good value when compared to spending on other health interventions.
- © 2012 by American Heart Association, Inc.