Study Finds that "Scan all Patients" Saves Money and Improves Care

Researchers found that performing immediate CT scans on all patients suspected of stroke led to overall cost savings and improved patient outcomes.

• Immediate scans for 1,000 patients 70-74 years old saved £286,000-about $490,000-compared to the traditional approach of scanning within 48 hours. The reason for the savings: CT led to more accurate diagnoses that, in turn, led to shorter hospital stays and improvements in patient outcomes.

The immediate-scan strategy also proved significantly more cost-effective than other strategies, including one in which CT was not used at all for stroke patients. In fact, immediate scanning cost 5.3 percent less than the no-scan strategy.

• The immediate-scan strategy proved the most cost-effective even though it entailed the highest costs for CT use when compared to a number of other strategies that varied the timing and availability of the scans. The researchers said that "these higher costs are offset by savings in the length of inpatient stay because many management decisions and better outcomes depend on accurate early diagnosis of stroke."

The researchers emphasized that their estimates were conservative and, therefore, may have underestimated the cost-effectiveness of immediate CT scans. With regard to improvements in quality of life, they stressed that even a slight shift from patient dependency to patient independence as a result of early diagnosis afforded by CT could mean dramatic reductions in length of stay and costs. "The balance is such that failure to use imaging judiciously could considerably increase the cost of stroke care," said the study

The researchers stressed that developing countries are suffering from higher costs and lower quality in stroke therapy because they have too few CT scanners. "The cost of installing CT scanners (or training more radiologists) would quickly be recouped in reduced costs of stroke to health services," the study said.

Costs for 1,000 Stroke Patients, Age 70-74
Perform CT scan on...	COST (£ in millions)	↓ %
...no stroke patients	10.55
...all patients within 48 hours	10.28	2.6%
...patients who are on anti-coagulation drugs or in life-threatening    condition immediately; all others in 48 hours	10.24	3.0%
...patients on anti-coagulation drugs, in life-threatening condition,    or candidates for anti-clotting drugs immediately; all others in    48 hours	10.23	3.1%
...patients who are on anti-coagulation drugs or in life-threatening    condition immediately; all others in 24 hours	10.07	4.6%
...patients on anti-coagulation drugs, in life-threatening condition,    or candidates for anti-clotting drugs immediately; all others in    24 hours	10.07	4.6%
...all stroke patients immediately	9.99	5.3%
The study shows that greater use of CT reduces long-term costs: Six strategies for scanning stroke patients with CT are shown above, ranging from no use of CT (in top row) to performing CT scans on all stroke patients immediately (on bottom row). Additional strategies reflecting variations in the timing of CT for specific types of patient conditions are shown in the middle rows. The percentage reduction in overall costs brought about by CT for each strategy—as compared to the "no scan" strategy—is shown in the right column. Note that the most intensive use of CT, which involves scanning all stroke patients immediately, saved the most in overall costs. Source: Wardlaw et al, Stroke, Nov 2004

"Immediate Computed Tomography Scanning of Acute Stroke is Cost-Effective and Improves Quality of Life," Wardlaw, JM; Seymour JC; Keir S; Lewis S; and Sandercock P, Stroke, November, 2004, pp. 2477-2483.