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Return on Investment in Endovascular Care: The Case of Endovascular Reperfusion Alberta

Published online by Cambridge University Press:  06 August 2021

Nguyen Xuan Thanh*
Affiliation:
Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada School of Public Health, University of Alberta, Edmonton, Alberta, Canada
Thomas Jeerakathil
Affiliation:
Department of Medicine (Neurology), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
Jillian Stang
Affiliation:
Data & Analytics (DIMR), Alberta Health Services, Red Deer, Alberta, Canada
Mary-Lou Halabi
Affiliation:
Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Balraj Mann
Affiliation:
Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Brian H. Buck
Affiliation:
Department of Medicine (Neurology), Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
Jeremy L. Rempel
Affiliation:
Department of Radiology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
Mayank Goyal
Affiliation:
Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Andrew M. Demchuk
Affiliation:
Department of Clinical Neurosciences & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Shelley Valaire
Affiliation:
Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Tracy Wasylak
Affiliation:
the Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada Strategic Clinical Networks, Alberta Health Services, Calgary, Alberta, Canada Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
Michael D. Hill
Affiliation:
Cardiovascular Health & Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada Department of Clinical Neurosciences & Hotchkiss Brain Institute, Departments of Community Health Sciences, Medicine and Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
*
Correspondence to: Nguyen Xuan Thanh, Strategic Clinical Networks, Alberta Health Services, 2-103 South Tower, Seventh Street Plaza, 10030 107 St., Edmonton, Alberta, Canada, T5J 3E4. Email: thanh.nguyen3@ahs.ca

Abstract:

Objective:

We examined the return on investment (ROI) from the Endovascular Reperfusion Alberta (ERA) project, a provincially funded population-wide strategy to improve access to endovascular therapy (EVT), to inform policy regarding sustainability.

Methods:

We calculated net benefit (NB) as benefit minus cost and ROI as benefit divided by cost. Patients treated with EVT and their controls were identified from the ESCAPE trial. Using the provincial administrative databases, their health services utilization (HSU), including inpatient, outpatient, physician, long-term care services, and prescription drugs, were compared. This benefit was then extrapolated to the number of patients receiving EVT increased in 2018 and 2019 by the ERA implementation. We used three time horizons, including short (90 days), medium (1 year), and long-term (5 years).

Results:

EVT was associated with a reduced gross HSU cost for all the three time horizons. Given the total costs of ERA were $2.04 million in 2018 ($11,860/patient) and $3.73 million in 2019 ($17,070/patient), NB per patient in 2018 (2019) was estimated at −$7,313 (−$12,524), $54,592 ($49,381), and $47,070 ($41,859) for short, medium, and long-term time horizons, respectively. Total NB for the province in 2018 (2019) were −$1.26 (−$2.74), $9.40 ($10.78), and $8.11 ($9.14) million; ROI ratios were 0.4 (0.3), 5.6 (3.9) and 5.0 (3.5). Probabilities of ERA being cost saving were 39% (31%), 97% (96%), and 94% (91%), for short, medium, and long-term time horizons, respectively.

Conclusion:

The ERA program was cost saving in the medium and long-term time horizons. Results emphasized the importance of considering a broad range of HSU and long-term impact to capture the full ROI.

Résumé :

RÉSUMÉ :

Retour sur investissement en matière de soins endovasculaires : le cas de la reperfusion en Alberta.

Objectif :

Dans cette étude, nous avons analysé le retour sur investissement (RSI) d’un projet de reperfusion endovasculaire (REV) mené, à l'échelle de la population, dans le cadre d’une stratégie financée par l’Alberta (Canada) pour améliorer l’accès au traitement endovasculaire (TEV) et pour mieux informer les décideurs publics en matière de pérennité.

Méthodes :

Nous avons calculé le bénéfice net (BN) comme étant le bénéfice moins les coûts ; le RSI, lui, représente le bénéfice divisé par les coûts. Les patients ayant bénéficiés d’un TEV de même que des témoins ont été identifiés à partir de l’essai clinique ESCAPE. Au moyen des base de données administratives des provinces, nous avons ensuite, en ce qui regarde leur utilisation de services de santé (USS), comparé entre eux les aspects suivants : les soins prodigués au moment de l’hospitalisation, les soins ambulatoires, les visites chez le médecin, les soins de longue durée et la prise de médicaments sur ordonnance. Le bénéfice réalisé a alors été extrapolé en fonction du nombre de patients ayant bénéficié d’un TEV, patients dont le nombre a augmenté en 2018 et en 2019 à la suite de la mise sur pied du projet de REV. Pour ce faire, nous avons utilisé 3 horizons temporels différents : 90 jours (court), douze mois (intermédiaire) et 5 ans (long).

Résultats :

Les TEV ont été associés à une réduction des coûts bruts d’USS pour ces trois horizons temporels. Compte tenu que les coûts totaux du projet de REV étaient de 2,04 M $ en 2018 (11,86 $ par patient) et de 3,73 M $ en 2019 (17,07 $ par patient), le BN par patient en 2018 (2019) a été estimé respectivement à -7,313 $ (-12,524 $), à 54,592 $ (49,381 $) et à 47,07 $ (41,859 $) pour les horizons court, intermédiaire et long. Le BN total de la province en 2018 (2019) a par ailleurs atteint, en million de dollars, -1,26 (-2,74), 9,40 (10,78) et 8,11 (9,14) pour ces mêmes trois horizons. Les ratios de RIS ont représenté 0,4 (0,3), 5,6 (3,9) et 5,0 (3,5). Enfin, la probabilité pour ce projet de REV de permettre une réduction de coûts a été respectivement de 39 % (31 %), de 97 % (96 %) et de 94 % (91 %) dans le cas des horizons court, intermédiaire et long.

Conclusion :

Ce projet de REV a ainsi représenté une réduction de coûts dans le cas des horizons intermédiaire et long. De tels résultats soulignent l’importance de tenir compte d’un large éventail de services de santé et de prendre en considération leurs impacts à long terme afin de cerner la totalité du RSI.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Canadian Journal of Neurological Sciences Inc.

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References

Boulanger, JM, Lindsay, MP, Gubitz, G, et al. Canadian stroke best practice recommendations for acute stroke management: prehospital, emergency department, and acute inpatient stroke care, 6th edition, update 2018. Int J Stroke. 2018;13:949–84.CrossRefGoogle ScholarPubMed
Alberta Health. Health system accountability and performance, surveillance and assessment branch. Health Trends Alberta; October 27, 2015. Available at: https://open.alberta.ca/dataset/297f9cbc-76e2-428c-9734-c8ffe537c770/resource/db2ea26b-1908-4547-91c7-715f9f1f2a43/download/hta-2015-10-27-stroke-htn.pdf; accessed December 4, 2020.Google Scholar
Alberta Health Services. Stroke mortality; 2015/2016. Available at: https://www.albertahealthservices.ca/assets/about/publications/ahs-pub-pr-2015-16-q2-detail-stroke-mortality.pdf; accessed December 4, 2020.Google Scholar
Goyal, M, Demchuk, AM, Menon, BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med. 2015;372:1019–30.CrossRefGoogle ScholarPubMed
Casaubon, LK, Boulanger, JM, Blacquiere, D, et al. Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015. Int J Stroke. 2015;10:924–40.CrossRefGoogle ScholarPubMed
Powers, WJ, Derdeyn, CP, Biller, J, et al. American Heart Association/American Stroke Association focused update of the 2013 guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2015;46:3020–35.CrossRefGoogle ScholarPubMed
Alberta Health Services. Endovascular Reperfusion Alberta (ERA) project. Cardiovascular Health and Stroke Strategic Clinical Network. 2020. Available at: https://www.albertahealthservices.ca/scns/Page13274.aspx; accessed December 4, 2020.Google Scholar
Thanh, NX, Patil, T, Knudsen, C, et al. Return on investment of the primary health care integrated geriatric services initiative implementation. J Ment Health Policy Econ. 2020;23:101–9.Google ScholarPubMed
Thanh, NX, Toye, J, Savu, A, Kumar, M, Kaul, P. Health service use and costs associated with low birth weight - a population level analysis. J Pediatr. 2015;167:551–6.CrossRefGoogle ScholarPubMed
CIHI. CMG+. Available at: https://www.cihi.ca/en/cmg; accessed November 26, 2020.Google Scholar
Alberta Health. Analytics and performance reporting branch. Interactive health data application: dementia. Available at: http://www.ahw.gov.ab.ca/IHDA_Retrieval/selectCategory.do; accessed November 26, 2020.Google Scholar
Alberta Health. Drug benefit list – publication. Available at: https://www.ab.bluecross.ca/dbl/publications.php; accessed November 26, 2020.Google Scholar
Drummond, MF, Sculpher, MJ, Torrance, GW, O’Brien, BJ, Stoddart, GL. Methods for the economic evaluation of health care programmes. 3rd edn. Oxford: Oxford University Press; 2005.Google Scholar
Lee, L, Mata, J, Ghitulescu, GA, et al. Cost-effectiveness of enhanced recovery versus conventional perioperative management for colorectal surgery. Ann Surg. 2015;262:1026–33.CrossRefGoogle ScholarPubMed
University of Calgary. Quality improvement and clinical research; 2020. Available at: https://cumming.ucalgary.ca/research/quicr/home; accessed December 3, 2020.Google Scholar
Alberta Health. Alberta health, analytics and performance reporting branch. Overview of administrative health datasets. Available at: https://open.alberta.ca/dataset/657ed26d-eb2c-4432-b9cb-0ca2158f165d/resource/38f47433-b33d-4d1e-b959-df312e9d9855/download/research-health-datasets.pdf; accessed December 3, 2020.Google Scholar
Stowers, MDJ, Lemanu, DP, Hill, AG. Health economics in enhanced recovery after surgery programs. Can J Anaesth. 2015;62:219–30.CrossRefGoogle ScholarPubMed
Briggs, A, Claxton, K, Sculpher, M. Decision modelling for health economic evaluation. New York: Oxford University Press; 2006.Google Scholar
Bank of Canada. Inflation calculator. Available at: https://www.bankofcanada.ca/rates/related/inflation-calculator/; accessed December 3, 2020.Google Scholar
Quan, H, Li, B, Couris, CM, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82.CrossRefGoogle ScholarPubMed
Thanh, NX, Nelson, A, Wang, X, et al. Return on investment of the enhanced recovery after surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada. Can J Surg. 2020;63:E542–50.CrossRefGoogle ScholarPubMed
Servick, LK, Demchuk, AM, Shuaib, A, et al. A prospective economic evaluation of rapid endovascular therapy for acute ischemic stroke. Can J Neurol Sci. 2021:18. DOI 10.1017/cjn.2021.4, Online ahead of print.CrossRefGoogle Scholar
Xie, X, Lambrinos, A, Chan, B, et al. Mechanical thrombectomy in patients with acute ischemic stroke: a cost-utility analysis. CMAJ Open. 2016;4:E316325. DOI 10.9778/cmajo.20150088.CrossRefGoogle ScholarPubMed
Brinjikji, W, Kallmes, DF, Rabinstein, AA, Lanzino, G, Cloft, HJ. Hospitalization costs for patients with acute ischemic stroke treated with endovascular embolectomy in the United States. Stroke. 2011;42:3271–3.CrossRefGoogle ScholarPubMed
Rai, AT, Evans, K. Hospital-based financial analysis of endovascular therapy and intravenous thrombolysis for large vessel acute ischemic strokes: the ‘bottom line’. J Neurointerv Surg. 2015;7:150–6.CrossRefGoogle ScholarPubMed
Kunz, WG, Almekhlafi, MA, Menon, BK, et al. Public health and cost benefits of successful reperfusion after thrombectomy for stroke. Stroke. 2020;51:899907.CrossRefGoogle ScholarPubMed
McMeekin, P, Flynn, D, Allen, M, et al. Estimating the effectiveness and cost-effectivenessof establishing additional endovascular thrombectomy stroke centres in England: a discrete event simulation. BMC Health Serv Res. 2019;19:821. DOI 10.1186/s12913-019-4678-9.CrossRefGoogle ScholarPubMed
Kamal, N, Rogers, E, Stang, J, et al. One-year healthcare utilization for patients that received endovascular treatment compared with control. Stroke. 2019;50:1883–6.CrossRefGoogle ScholarPubMed
Dewey, HM, Thrift, AG, Mihalopoulos, C, et al. ‘Out of pocket’ costs to stroke patients during the first year after stroke - results from the North East Melbourne stroke incidence study. J Clin Neurosci. 2004;11:134–7. DOI 10.1016/s0967-5868(03)00148-6.CrossRefGoogle ScholarPubMed
Dunbar, SB, Khavjou, OA, Bakas, T, et al. Projected costs of informal caregiving for cardiovascular disease: 2015 to 2035 - a policy statement from the American Heart Association. Circulation. 2018;137:e558–77. DOI 10.1161/CIR.0000000000000570.CrossRefGoogle ScholarPubMed
Joo, H, George, MG, Fang, J, et al. A literature review of indirect costs associated with stroke. J Stroke Cerebrovasc Dis. 2014;23:1753–63. DOI 10.1016/j.jstrokecerebrovasdis.2014.02.017.CrossRefGoogle ScholarPubMed
Ganapathy, V, Graham, GD, DiBonaventura, MD, et al. Caregiver burden, productivity loss, and indirect costs associated with caring for patients with poststroke spasticity. Clin Interv Aging. 2015;10:17931802.Google ScholarPubMed

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