The Cost-Effectiveness of Primary Stroke Centers for Acute Stroke Care

BACKGROUND AND PURPOSE: Primary stroke centers (PSC) have demonstrated improved survival in patients with acute ischemic stroke (AIS). The objective of this study was to evaluate the cost-effectiveness of treating AIS patients in a PSC compared with a nonPSC hospital setting. METHODS: We developed a decision analytic model to project the lifetime outcomes and costs of 2 hypothetical cohorts of 75 AIS patients. Clinical data were derived from a recent observational study comparing PSC- and nonPSC-admitted patients, clinical trials, longitudinal cohort studies, and health state preference studies. Cost data were based on Medicare reimbursement and other published sources. We used a healthcare payer perspective, and the primary outcomes were incremental life expectancy, quality-adjusted life years, and healthcare costs. We performed sensitivity and scenario analyses to evaluate uncertainty in the results. RESULTS: Admission to a PSC resulted in a gain of 0. 22 years of life (95% credible range CR, 0. 12-0. 33) and 0. 15 quality-adjusted life years (95% CR, 0. 08-0. 23) per patient, at a cost of 3600 (95% CR, 2400-5000) per patient, compared with admission to a nonPSC hospital. The incremental cost/quality-adjusted life year gained was 24 000, and all probabilistic simulation results were below the 100 000/quality-adjusted life year threshold. In scenario analyses accounting for as few as 7 and as many as 500 AIS patients/year per PSC, cost-effectiveness improved as the number of AIS patients admitted per year increased. CONCLUSIONS: Our study indicates that care at a PSC for patients with AIS is cost-effective and improves outcomes across a wide range of possible scenarios.