Should TIA patients be hospitalized or referred to a same-day clinic? A decision analysis
Should TIA patients be hospitalized or referred to a same-day clinic? A decision analysis
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DOI：
10.1212/wnl.0b013e31823d763f
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发表时间：
2011-12-01
期刊：
影响因子：
9.9
通讯作者：
Prabhakaran, Shyam
中科院分区：
文献类型：
--
作者：
Joshi, Jay K.;Ouyang, Bichun;Prabhakaran, Shyam
目的：对于TIA患者，先前的一项研究得出结论，与急诊科不治疗的出院相比，住院治疗具有成本效益。我们进行了成本效益分析住院与紧急诊所评估后TIA.Methods：在一个队列的TIA患者，我们创建了一个决策树模型，比较决定住院或参考紧急访问专科诊所。我们从现有文献中估计了概率、效用和直接成本，并计算了增量成本效果比（ICER）。我们假设两种方法之间的标准药物治疗机会相同;然而，我们估计住院患者中组织纤溶酶原激活剂（tPA）的利用率较高。我们进行了敏感性分析，以评估我们的model.Results中的所有假设：在TIA患者年龄65-74岁，住院治疗产生额外的0.00026质量调整生命年（QALY）在1年，但在一个额外的成本为5,573美元，每例患者相比，紧急诊所评估（ICER = 21,434,615美元/QALY）。30年来，ICER为3，473，125美元/QALY。这些结果是不敏感的不同48小时中风的风险，住院时间，tPA的利用率，每tPA治疗，住院和诊所的费用，每tPA treatment.Conclusion节省的QOLS：尽管增加了在医院获得tPA，我们发现，住院治疗是不符合成本效益相比，TIA后同一天的诊所评估。如果有紧急访问TIA诊所，只有很少一部分患者受益于住院治疗。紧急访问TIA诊所的广泛发展是必要的。神经病学（R）2011; 77：2082-2088
Objective: For patients presenting with TIA, a previous study concluded that hospitalization is cost-effective compared to discharge without treatment from the emergency department. We performed a cost-effectiveness analysis of hospitalization vs urgent clinic evaluation following TIA.Methods: Among a cohort of TIA patients, we created a decision tree model to compare the decision to hospitalize or refer to urgent-access specialty clinic. We estimated probabilities, utilities, and direct costs from the available literature and calculated incremental cost-effectiveness ratio (ICER). We assumed equal access to standard medical treatments between the 2 approaches; however, we estimated higher tissue plasminogen activator (tPA) utilization among hospitalized patients. We performed sensitivity analyses to assess all assumptions in our model.Results: In patients with TIA aged 65-74 years, hospitalization yielded additional 0.00026 quality-adjusted life-years (QALYs) at 1 year, but at an additional cost of $5,573 per patient compared to urgent clinic evaluation (ICER = $21,434,615/QALY). Over 30 years, the ICER was $3,473,125/QALY. These results were not sensitive to varying 48-hour stroke risk, length of stay, tPA utilization rate, QALYs saved per tPA treatment, and hospitalization and clinic costs, and cost saved per tPA treatment.Conclusion: Despite increased access to tPA in the hospital, we found that hospitalization is not cost-effective compared to same-day clinic evaluation following TIA. A very small fraction of patients benefits from hospitalization if urgent-access TIA clinics are available. The widespread development of urgent-access TIA clinics is warranted. Neurology (R) 2011; 77: 2082-2088