An exploratory economic evaluation of the impact of improving clinician adherence to stroke clinical guidelines

Objective: Little is known about the economic impact of implementing Clinical Guidelines for Stroke Management (CGSM) in Australian private hospitals. This study completed an exploratory economic evaluation of a clinician-led CGSM implementation intervention, within an Australian private health service. Methods: Observational study of inpatient stroke cohorts. Primary outcome: cost-effectiveness of the CGSM implementation process for acute and rehabilitation wards from a health care sector perspective. Secondary outcome: CGSM implementation cost. Data were collected pre and post CGSM implementation via medical record audits, health service administration and surveys. Cost analyses used public health modelled data and individual patient health service data. Results: Acute: no significant differences in cost per patient with a difference in modelled data of $160 (95%CI: -$5,061 to 0.07, p=0.16) following implementation of CGSM. Rehabilitation: non-significant increase in cost per patient with modelled data reporting a difference of $5,969 (95%CI: -$12,230 to $291; p=0.070) (AUD$5,969; Euro€3,829; USD$4,443) and a statistically significant improvement in functional status [FIM 10.45 (95%CI: 0.4 to 20.5), p=0.041] post-implementation of CGSM. The incremental cost effectiveness ratio was an additional $1,605 (AUD$1,605; Euro€1,030; USD$1,195) per 1-point FIM score gained. CGSM implementation cost was $154,717 (AUD$154,717; Euro€99,281; USD$115,186) and it utilised 2,099 staff hours. Conclusion: While CGSM implementation in private health did not result in cost savings, there was a positive effect on patient function during rehabilitation. Key Words: Stroke; Clinical guidelines; Private health service; Implementation; Health economics; Cost-effectiveness $4,741, p=0.499) (AUD$160; Euro€103; USD$119); and health service data of -$422 (95%CI: -$1,482 to $2,326, p=0.665) (AUD-$442; Euro- €284; USD-$329), or in functional status MRS -0.18 (95%CI -0.44 to 0.07, p=0.16) following implementation of CGSM. Rehabilitation: non-significant increase in cost per patient with modelled data reporting a difference of $5,969 (95%CI: -$12,230 to $291; p=0.070) (AUD$5,969; Euro€3,829; USD$4,443) and a statistically significant improvement in functional status [FIM 10.45 (95%CI: 0.4 to 20.5), p=0.041] post-implementation of CGSM. The incremental cost effectiveness ratio was an additional $1,605 (AUD$1,605; Euro€1,030; USD$1,195) per 1-point FIM score gained.  CGSM implementation cost was $154,717 (AUD$154,717; Euro€99,281; USD$115,186) and it utilized 2,099 staff hours. CONCLUSION:  While CGSM implementation in private health did not result in cost savings, there was a positive effect on patient function during rehabilitation.