THE POTENTIAL ECONOMIC IMPACT OF RECONFIGURING TIA CARE IN ITALY

OBJECTIVES: Due to a lack of awareness of Transient Ischaemic Attack (TIA) symptoms, many patients may not immediately seek medical help, creating a delay in access to treatment.  The UK EXPRESS study by Rothwell et al. (Lancet 2007;370:1432–42) demonstrated that greater focus on effectively managing TIA could have a significant impact on subsequent stroke rates.  With nearly 200,000 strokes occurring in Italy each year, we wanted to examine how a shift in care pathways towards that outlined in phase 2 of the EXPRESS study could affect rates of stroke, and explore the financial implications of such a shift in care pathway. METHODS: We developed an economic model to estimate the costs and savings associated with establishing a rapid assessment and treatment clinic for patients with suspected TIA in Italy, in line with phase 2 of the EXPRESS study.  We used a population of 1,000,000 people with an assumed annual incidence of TIA of 0.058%.  Current management was based on ESO guidelines and common clinical practice.  We included direct costs associated with care (medications, diagnostics and staff – where data were unavailable, UK converted costs were used), and modelled the impact of changing management over three years. RESULTS: For a population of 1,000,000, changing the pathway of care to ensure rapid assessment and treatment for TIA patients would result in 180 future stroke events being avoided over three years.  As a result, additional costs associated with changing the TIA pathway of care were offset by savings generated through avoiding acute stroke management costs. CONCLUSIONS: Our model suggests that implementing a revised TIA care pathway in Italy would be cost saving.  For a local population of 1,000,000, savings associated with the avoidance of acute stroke management would offset the costs of establishing rapid assessment and treatment clinics for patients experiencing TIA.