Monash research saves lives and health costs

Prof Thanh Phan

In a landmark study, researchers from Monash University have shown the cost-effectiveness of nonadmission-based care for mini-stroke patients.

Adjunct Clinical Professor Thanh Phan and colleagues from the School of Clinical Sciences at Monash Health (SCS) published their microcosting study in Neurology: Clinical Practice, an official journal of the American Academy of Neurology.

Stroke is the second single greatest killer and one of the leading causes of disability amongst

adults in Australia.

A mini-stroke, or transient ischaemic attack (TIA) happens when the blood supply to the brain is interrupted for a short period of time and is often a warning that a stroke may occur.

“TIA requires urgent treatment,” said Professor Phan. “A recent analysis of TIA care in the United States indicated 70 per cent of patients were admitted for 2-6 days with average hospitalisation charges of $17,000 USD per patient.”

However, earlier studies have proven rapid outpatient-based TIA management to be safe and associated with low stroke rates within 90 days.

“At Monash Medical Centre we have shown that a structured model of outpatient care, the Monash TIA Triaging Treatment (M3T) pathway, is safe and effective compared with a previous admission-based model,” said Professor Phan.

Beyond improved patient care, Professor Phan’s research demonstrates a significant cost savings when TIA patients are managed as outpatients rather than admitted to hospital.

“A TIA patient treated in the previous admission-based model cost an average of $4,841 AUD whereas the average total episode cost for an M3T patient was significantly less at $1,927 AUD.” This represents an approximate saving of $3000 per patient.

“Importantly, in M3T, a net cost shift from inpatient to outpatient settings did not occur, and a true reduction in per-patient episode costs was achieved,” said stroke health economist Associate Professor Dominique Cadilhac.

“We estimate that only 23 patients needed to be treated in M3T per annum to offset the extra weekly clinic costs, suggesting its feasibility even in hospitals with small caseloads.”

The research team included SCS PhD candidate Dr Lauren Sanders and Director, Stroke and Ageing Research Centre, Associate Professor Velandai Srikanth and Associate Professor Dominique Cadilhac.

The National Stroke Foundation  reports 709,000 Australians, or 2.4% of the population, will be living with stroke by 2032.  The same report estimated the total financial costs of stroke in 2012were $5 billion, and of this major burden, health costs were a significant $881 million.