Daily Pharmacy News

Get your free subscription started now. Just enter your email address below.

CEA of Quality Measures in Care of Acute Ischemic Stroke

Of the 15 process measures for acute ischemic stroke (AIS) endorsed by the American Heart Association and American Stroke Association (AHA/ASA), benefits are highly concentrated in 5 of 10 measures assessed in a cost-effectiveness analysis (CEA), a study shows. “Our results can help providers and payers set priorities for quality improvement efforts and value-based payments in AIS care,” conclude the authors.

The study used an individual-based stroke simulation model to consider the effects of the 10 quality measures with sufficient clinical evidence in AIS care: use of tissue plasminogen activator and time to tPA, early use of antithrombotics, prophylaxis against venous thromboembolism, cardiac monitoring, early carotid imaging, discharged on antithrombotics, discharged on anticoagulation, discharged on statins, and tobacco use counseling. Using a target population of U.S. patients with incident AIS, a lifetime horizon, and the perspective of the healthcare sector, the CEA compared current versus complete (100%) implementation of the measures at the population level.

Outcome measures of life-years, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios, and incremental net health benefits showed these patterns: “Discounted life-years gained from complete implementation would range from 472 (tobacco use counseling) to 34,688 (early carotid imaging) for an annual AIS patient cohort. All AIS quality measures were cost-saving or highly cost-effective by AHA standards (<$50 000 per QALY for high-value care). Early carotid imaging and intravenous tissue plasminogen activator contributed the largest fraction of the total potential value of quality improvement (measured as incremental net health benefit), accounting for 72% of the total value. The top 5 quality measures accounted for 92% of the total potential value.”

Source: Annals of Internal Medicine