Cost-effectiveness of a Quality Improvement Project Reducing Door-to-needle times in Stroke Thrombolysis (1090-003949) (Award Winning Abstract)
Start time: Tuesday, January 19, 2021, 1:00 PM End time: Tuesday, January 19, 2021, 2:00 PM Session Type: Research Abstracts (Completed Studies)
Stroke is the second leading cause of death and disability worldwide (1). Rapid revascularization in acute ischemic stroke is crucial to reduce the total burden of stroke including societal costs. A quality improvement project including protocol revision and simulation-based training was followed by a considerable reduction in median door-to-needle time (27 to 13 min) and improved patient outcomes in stroke thrombolysis after 13 months at our centre (2). In the present study, we aim to retrospectively determine the costs of implementing and maintaining the quality improvement project, including costs of simulation-based training, and relating the costs to the observed effects in a cost-effectiveness analysis. There are few reports that describe the costs involved in implementing and running a simulation-based training intervention as part of a quality improvement project. A formal cost-effectiveness analysis could assist decisionmakers to prioritize such projects.
Costs for implementing and maintaining quality improvement were assessed using recognized frameworks for cost reporting in quality improvement and simulation-based training. Effectiveness was calculated from previously published outcome measures (2). Cost-effectiveness was presented as annual costs per minute door-to-needle time reduction, and as costs per averted death in the 13-month post-intervention period. We projected future cost-effectiveness for a 5-year period. Costs were calculated including and excluding costs of donated time.
We observed a mean reduction in door-to-needle time of 13.1 min per patient and 6,36 averted deaths annually. All costs, including fixed costs for implementing the quality improvement project totalled 40 086 €, while costs for maintaining quality improvement were 1916 € per month. The estimated costs per minute reduction in door-to-needle time ranged from 12-26 € across different scenarios, and the estimated costs per averted death ranged from 4439-9433 €. In the 5-year future cost-effectiveness projection, estimated costs per minute averted in the fifth year was 3 €, while costs per death averted was 1 017 € excluding costs of donated time.
Economic consequences of quality improvement projects including simulation-based training interventions are rarely reported. We have shown that a QI project including in-situ-simulation based training sessions can be implemented and maintained at a relatively low cost with increasing cost-effectiveness over time. The presented cost-effectiveness data might help guide decisionmakers planning similar interventions.