Cost-Effectiveness Analysis of Ambulatory Treatment Based on Eco-Doppler Examination for Patients with Transient Ischemic Attack (Tia)

Background: Innovation in healthcare, both technological and organizational, is a main determinant of increments in healthcare expenditures in developed countries. Decision-making based on efficiency criteria aims to moderate budgetary increments while maintaining current healthcare outcomes.

Objectives: To carry out a cost-effectiveness analysis (CEA) of two alternative strategies to manage patients with TIA.

Methods: A partial stochastic cost-effectiveness analysis has been carried out. Effectiveness data were collected by means of a cohorts study. Costs data were collected from the accounting system of a regional hospital. Analysed effectiveness variables are relapse of TIA, cardiac events following TIA, disability degree after TIA, and vascular death. Direct average costs of each alternative were analysed.

Results: Ambulatory treatment average cost for TIA (€698.24) is markedly lower than hospitalization cost, considering both costs of DRG or stays (€2,615.67 and €4,144.54 respectively). There are no significant differences in effectiveness between the alternatives (p>0.05 in all cases). Cost-effectiveness results show that ambulatory treatment is clearly superior to hospitalization if effectiveness is assessed as cardiac events or disability after TIA. If effectiveness is assessed as relapse of TIA or survival after TIA, hospitalization is more effective than ambulatory treatment, but with a high cost per additional unit of outcome gained between €111,171 and €289,605.

Conclusions: The general application of ambulatory treatment for TIA patients after Doppler examination presents better cost-effectiveness results than hospitalization, thereby freeing a significant amount of resources for other uses.