Improving care for patients with stroke impacts health outcomes and the economy

Associate Professor Cadilhac

Monash University researchers from Stroke and Ageing Research, School of Clinical Sciences at Monash Health, have shown that if acute stroke care was improved to that of Australian benchmarks, more than 9300 disability-adjusted life years could be avoided every year, at minimal cost to the health system.

Stroke is a leading cause of death and disability in Australia, and the associated economic burden is significant.

 “The average lifetime costs of first-ever stroke in Australia is approximately $100,000, comprising health costs and loss of productivity,” said senior researcher Associate Professor Dominique Cadilhac.

“While acute stroke treatment guidelines include stroke unit care, intravenous thrombolysis for patients with ischemic stroke and medication for secondary prevention, evidence suggests that eligible patients may not always receive these therapies—even in well-resourced settings.”

The research team estimated the health and economic benefits from improving standards of care, and converted their results to disability-adjusted life years (DALYs) avoided.  A DALY is a year of life lost due to illness, disability, or early death.

“Using 2013 patient data, we estimated that if hospitals had achieved the benchmark acute stroke care standards, 285 recurrent strokes and 977 deaths or disabilities would have been prevented,” said Dr Joosup Kim who did the modelling analysis.

“This translates to 9329 DALYs avoided; and these health benefits could be delivered at an additional cost of $30.8 million or approximately $3304 per DALY avoided.”

Dr Kim explained that considerable gains in health may be achieved at relatively low costs by improving the average standard of acute stroke care in Australia to the standard of top performing hospitals.

“The estimate of $3304 per DALY avoided is considered to be highly cost effective since the willingness to pay for an additional year of healthy life is generally accepted as less than the national annual gross domestic project per capita (approximately $50,000 in Australia).”

The evidence-based therapies included in the research team’s analysis are already recommended in guidelines, further emphasising the potential benefits of implementing current knowledge.

“These are benefits that could be achieved with investment in clinician behaviour change, health service redesign, and support structures within the clinical setting to attain achievable benchmarks,” said Associate Professor Cadilhac.