Stroke strikes every 45 seconds in the U.S. It kills every 3 minutes. Stroke is also the primary cause of long-term disability – some 4.6 million Americans are stroke survivors; 30 percent of these individuals require institutional care or are disabled. Medical imaging helps reduce the economic and human burden of stroke by fostering treatments that reduce the likelihood of long-term disability and nursing home care.
Imaging Plays Key Role in Enabling Thrombolytic Therapy
This flowchart identifies the timing of events for diagnosing and treating stroke once the patient enters the hospital as outlined by the National Institute of Neurological Disorders and Stroke. Imaging is a fundamental step in thrombolytic therapy that results in overall treatment savings and lives saved. Source: "Stroke: Effect of Implementing an Evolution and Treatment Protocol Compliant with NINDS Recommendations," Stahl JE, et al, Radiology, 228; 3; 659-668, 2003.
Medical imaging enables use of cost-saving and life-saving thrombolytic therapy – the only approved drug treatment for ischemic brain attack.1 Imaging tells physicians about the cause of the stroke, the location, and the extent of brain injury. Once they have this information, they can begin thrombolytic drug therapy.2
As such, rapid imaging is widely recognized as an essential element of successful stroke treatment.3
The average length of hospital stays for patients who receive thrombolytic therapy is significantly shorter than for patients who do not (10.9 days versus 12.4 days), according to one study. Some 48 percent of thrombolytic-treated patients (versus 36 percent of non-thrombolytic treated patients) went home from the hospital rather than to a nursing home.4Click here to view the study
Per 1,000 patients, thrombolytic drug treatment creates overall savings to the health care system by increasing hospital costs $1.7 million, but decreasing rehabilitation costs $1.4 million and nursing home costs $4.8 million.
Medical imaging is working to expand the ability of thrombolytic therapy to save lives and costs. Though thrombolytic treatment must be administered within 3 hours after symptoms appear, preliminary studies show that advances in imaging (for example, perfusion computerized tomography) can extend the 3-hour time window even further, thus further extending savings in lives and dollars.5
Medical imaging enables surgery that has been shown to reduce stroke and disability – and that can save money as a result.
Nussbaum et al in the journal Neurosurgery found that carotid endarterectomy – a surgery which removes plaque from the arteries that supply blood to the brain – saves anywhere from $3,000 to $5,700 per patient compared to the costs of taking no action.6 These figures reflect the cost savings in reduced long-term hospitalization, rehabilitation, and nursing home care for patients who ultimately experience a stroke. Click here to view the study
A variety of imaging technologies help physicians decide whether carotid endarterectomy is appropriate. These include CT scans of the brain, diffusion-weighted imaging, perfusion-weighted imaging, and PET scans.7 Imaging is also introducing new treatment options for opening clogged carotid arteries, including carotid artery angioplasty and carotid artery stents.8
The two columns at the right show that carotid surgery reduces long-term treatment costs, reflecting, in part, the reduced costs of long-term care associated with stroke. Such treatments are facilitated by imaging technologies that inform physicians of the degree of stenosis in the carotid arteries. Source: "Cost Effectiveness of Carotid Endarterectomy Clinical Study," by Nussbaum ES, Heros RC, Erickson DL, in Neurosurgery, 38; 237-244; 1996.
1 "Reborn Workhorse, CT, Pulls the Wagon Toward Thrombolysis Beyond 3 Hours," Kaste M, Stroke, 35:357-359, 2004. 2 "Stroke Tests," American Stroke Association at www.strokeassociation.org, and "Diagnosis as a Guide to Stoke Therapy," The Lancet, Vuadens P, and Bogousslavsky J, 1998: (suppl III.) 59. 3 "Stroke Treatment: Time is Brain," Hill MD, and Hachinski V, The Lancet, 1998; 352 (suppl III) 1014. Also see "Practice Guidelines: Use of Imaging in Transient Ischemic Attacks/Acute Stroke," A Report of the Stroke Council, American Heart Association, Stroke, 1997; 28:1480-1497. 4 "Cost-Effectiveness of Tissue Plasminogen Activator for Acute Ischemic Stroke. NINDS rt-PA Stroke Study Group," Fagan SC, Morgenstern LB, Petitta A, Ward RE, Tilley BC, Marler JR, Levine SR, Broderick JP, Kwiatkoski TG, Frankel M, Brott TG, and Walker MD, in Neurology, 50, 4: 883-890. 5 "Advances in Stroke 2003: Introduction," Hachinski V, Stroke, 35:341, 2004. 6 "Cost Effectiveness of Carotid Endarterectomy Clinical Study," Nussbaum ES, Heros RC, Erickson DL, Neurosurgery, 38; 237-244; 1996. 7 "The Value of Investment in Health Care: Better Care, Better Lives," MedTap International, p. 34, 2004. 8 Carotid stents are under pre-market evaluation by the U.S. Food and Drug Administration.
