OBJECTIVES: Stroke has a significant health impact and presents an ongoing challenge for the ongoing availability of healthcare resources. These rising healthcare costs have been partly attributed to the utilization of advanced imaging with CT angiography and perfusion (CTAP). Thus, we investigate the budget impact of implementing advanced imaging for diagnosis and treatment decision-making in acute stroke patients at a comprehensive stroke center (CSC).

METHODS: We employed simulation modeling methods evaluating two hypothetical scenarios: (A) patients with stroke symptoms initially undergo non-contrast-CT (NCCT) and later return to the scanner for angiography (CTA) or angiography and perfusion (CTAP) imaging when endovascular treatment is considered, and (B) all patients with stroke symptoms undergo CTAP as initial imaging. Our institutional data was utilized as model inputs to provide an example of a large healthcare system (n=1506 acute ischemic stroke patients annually). A base-case model was used to calculate the within-hospital per-patient costs needed to achieve the diagnosis. Sensitivity analyses were performed.

RESULTS: There was no initiation cost for advanced imaging for the stroke service. The average per-patient clinical cost for achieving a diagnosis was $631.49 for scenario A and $788.68 for scenario B. The average per-patient treatment costs were $1,344.30 for scenario A and $2,877.30 for scenario B. The overall cost of scenario B is $5,535,294, while the overall cost of scenario A is $2,975,151 in the first year. The overall budget impact of scenario B is $2,560,143 in the first year of implementation.

CONCLUSIONS: Our study shows that establishment of advanced imaging is financially feasible and requires no additional investment in overhead CT equipment or personnel. Advanced imaging in stroke care leads to much larger budget impact on the treatment than on diagnostics services. However, hospitals changing their stroke care to advanced imaging need to be prepared to handle significantly higher volume of treatment cases.