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O-002 developing an interventional stroke service: improving clinical outcomes and reducing cost and delivering great cost saving benefits to health economy
  1. S Nayak
  1. Neuroradiology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom, Newcastle Under Lyme, UK


Purpose To improve patient clinical outcomes and provide cost saving benefits to our local organization, community care and the National Health Service (NHS) within in the United Kingdom, by treating patients presenting with large vessel occlusive stroke by Mechanical Thrombectomy.

Materials and methods All patients treated with mechanical Thrombectomy (MT) for acute stroke at UHNM, Stoke-on-Trent, UK, were entered into a prospective register. Baseline demographic, imaging and clinical data, outcome scores, duration of patient stay, discharge destinations and other relevant data for cost analysis were recorded. Mortality, and modified Rankin score (mRS) were assessed at 90 days. We performed a detailed analysis of Clinical outcomes as measured by 90 days mRS score and correlated it to the resultant costs savings to our NHS Hospital from the reduced bed days for the inpatient stay and the financial savings to the social care in terms of reduced costs due to patient clinical improvement and reduced disability. We used shift analysis (shift to lower mRS score) to deduce the savings of patient costs to the hospital and social care due to improvement in the clinical outcome with resultant cost saving for every grade of downward mRS Score shift. We also extrapolated our local institutional cost savings to the UK national data.

Results From January 2010 to December 2014 we identified 198 patients treated with mechanical Thrombectomy. Our institution has the largest patient series in UK for patients undergoing mechanical Thrombectomy for severe strokes. 47% of patients were alive and independent (mRS <2) and the mortality rate was 17%. This significantly reduced the length of stay with median in-hospital stay being 14 days when compared to 90 days previously. 91% of live discharges are now discharged home when compared to a nursing home previously. From our patient series this produced a net savings to health and social care costs of £3.2 m or £684,000 per 100,000 populations served. These are summarized as follows; savings of £2.4 million from a reduction in the length of stay in hospital, a reduction  of £1.6 million in social care costs. Based on the current local tariff an income of £1.0–£1.2 million was generated from Mechanical Thrombectomy procedures for our hospital. Extrapolating the data we estimate that around 20000 to 25000 potential patients could benefit from mechanical Thrombectomy within the UK if used as a mainstream treatment for large vessel strokes.

Conclusion Mechanical Thrombectomy has shown benefit in improving clinical outcomes with significant cost saving benefit to our institution and the community care. If the cost saving benefits is extrapolated to the stroke population of the United Kingdom or any other western country with a similar healthcare structure, this will lead to major savings to the healthcare economy. For this to materialize, there needs to a larger government initiative to streamline stroke pathways and provide adequate funding to develop this service uniformly across the country.

Disclosures S. Nayak: None.

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