Every Minute Counts in Treating Stroke

 

The Society of NeuroInterventional Surgery (SNIS) announced findings from a study using a Markov model of lifetime quality-adjusted life years (QALYs) in patients treated with endovascular thrombectomy (EVT) that showed that every 10 minutes of delayed care reduced a patient’s disability-free lifetime by approximately 40 days. The study, "Lifetime Quality-of-Life and Cost Consequences of Treatment Delays in Endovascular Thrombectomy for Stroke Based on HERMES Data," was presented at the SNIS 15th annual meeting held July 23–26 in San Francisco, California.

In addition to analyzing a patient’s QALY, the study evaluated health care and societal costs, which include losses of productivity and informal care given by family members.

The study found that time delays to EVT significantly reduce the economic value of stroke care. A time delay of 10 minutes reduced the net monetary benefit of EVT by approximately $10,000, for both health care system or societal perspectives. The economic value is defined as the amount of health expenditures needed to achieve QALYs for a patient in a particular health care setting. Net monetary benefit is an economic measure that accounts for the value of care by combining weighted QALYs and costs into one composite outcome, explained SNIS.

The investigators' recommendations for more immediate treatment include improving emergency medical services (EMS) protocols, as well as improving in-hospital workflow by notifying the hospital in advance to have the full stroke team ready when the patient arrives in the emergency department and by distributing tasks among a coordinated stroke team.

Senior investigator of the study, Mayank Goyal, MD, put the findings into practical perspective, saying, "With budget constraints and limitations, one needs data to justify expenditure. These data indicate that it would be reasonable to spend $250 million to improve stroke systems of care in the US. We already had evidence to show that time is brain. Now we can say that time is money as well."

 

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Launched in 2002, Practical Neurology is a publication uniquely dedicated to presenting current approaches to patient management, synthesis of emerging research and data, and analysis of industry news with a goal to facilitate practical application and improved clinical practice for all neurologists. Our straightforward articles give neurologists tools they can immediately put into practice.

 
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