PRACTISE saves money in stroke care

By Eleanor McDermid

The PRACTISE intervention to boost stroke thrombolysis rates is not just cost-effective, but cost-saving, show the results of a prespecified analysis.

In an editorial accompanying the study in Neurology, Anthony Kim (University of California, San Francisco, USA) and Kate Young (University of Rochester, New York, USA) say that "this intervention appeared to pay for itself and then some."

When applied in a cluster-randomized, controlled trial involving 12 Dutch hospitals and 5515 stroke patients, the PRACTISE (PRomoting ACute Thrombolysis in Ischemic StrokE) intervention resulted in a 58% rise in the use of thrombolysis in eligible patients (44.3 vs 39.8%).

But this increased thrombolysis rate worked out significantly cheaper than the usual standard, with average costs per patient at 3 months after stroke totaling US$ 9192 versus 9647 (€ 7581 vs 7956), report Maaike Dirks (Erasmus MC University Hospital Rotterdam, the Netherlands) and team.

Patients in the intervention group gained an average of 0.05 quality-adjusted life-years (QALYs) over those in the control group (3.89 vs 3.84), which was not statistically significant. The total lifetime cost of stroke, based on disability-stratified probabilistic life tables, was US$ 22,994 (€ 18,964) in the intervention group and $24,325 (€ 20,062) in the control group, which was a significant difference.

The PRACTISE intervention was based on the Breakthrough Series model, which involves coordination, goal-setting, and feedback designed to address local barriers to thrombolysis identified by a multidisciplinary team.

This makes the model widely applicable, but Kim and Young note that "this flexibility also makes it more difficult to identify what specific changes were actually instrumental in achieving the improvement in thrombolysis rates."

They also point out that the failure to demonstrate a significant QALY gain "dampens the impact" of the cost savings, although they note that the trial was not powered to detect clinical benefits.

Kim and Young therefore conclude that "the prospect of a potentially cost-saving intervention shown here should renew collaborative and innovative efforts to increase thrombolysis rates."

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