Penaloza-Ramos et al. did a very interesting and useful cost effectiveness analysis using TreeAge software (decision tree analysis) to evaluate the utility and cost effectivess of different strategies to improve tpa thrombolysis for acute ischemic stroke patients.

Not surprisingly, tpa has been previously shown to be cost saving for patients. This study shows that implementing strategies to increase the utilization of tpa for ischemic stroke patients can be further cost saving for a population. Different change strategies were studied and the most cost savings strategies included better recording of onset time (last seen normal time) which resulted in 3.3 additional QALYs and $46,000 per 100,000 patients saved.

This article used real patient data from two geographic regions (health trusts) of U.K  so the reliability of the data is assured. This data was used as the base case. The interventions tested included both optimal change and a more realistic intervention size which increases the realism of the projected cost savings and outcome improvements. Sensitivity analyses proved that it was cost saving and quality improving in all cases.

Hopefully, with computer simulated studies using real patient data such as this one, more healthcare systems and governments are willing to put the resources in place to motivate action to improve thrombolysis of acute ischemic strokes. Currently, only a modest 5-7% of acute ischemic stroke patients are estimated to receive IV TPA in the United States. We can easily increase the use of iv tpa for ischemic stroke patients with simple strategies such as that listed in this article, and potentially improve the quality of life of many patients and save costs for society.

As more attention is being focused on the value of healthcare we delivery, implementation of different strategies to increase IV TPA use becomes more important.