Cost-effectiveness analysis of clinical pathway for different TOAST subtypes of patients with acute cerebral infarction

Abstract

Objective To evaluate the cost-effectiveness of clinical pathway for different Trial of Org 10172 in Acute Stroke Treatment (TOAST) subtypes of patients with acute cerebral infarction (ACI). Methods ACI clinical pathway was developed according to the characteristics of our hospital. A total of 1036 ACI patients were recruited. They were divided into control (n=472) and pathway (n=564) groups. The hospitalization time, hospitalization expenses and clinical outcomes between two groups of different TOAST subtypes were compared. Good clinical outcome was defined as a modified Rankin Score (mRS) of 0-2. Results Compared to control group, the lengths of stay for ACI patients in pathway group were significantly shorter (P=0.004) while those with good clinical outcomes were significantly higher (P=0.002). Furthermore, the lengths of stay for large artery atherosclerosis (LAA) subtype patients in pathway group were shorter (P=0.000), both total hospital charges and medication costs were significantly reduced (P=0.044, 0.036) while those with good clinical outcome were significantly higher (P=0.002); the differences among other four subtypes of small artery occlusion (SAO), cardioembolism (CE), stroke of other etiology (SOE) and stroke of undetermined etiology (SUE) were not statistically significant. Conclusion The implementation of clinical pathway may offer more benefits to LAA subtype ACI patients than other subtypes. Key words: Cerebrovascular Accident; Clinical pathways; Prognosis