Evaluating the cost-utility of a direct transfer to angiosuite protocol within 6 h of symptom onset in suspected large vessel occlusion patients

Catalonia healthcare; Cost-utility; Large vessel occlusionSanitat de Catalunya; Cost-utilitat; Oclusió de grans vasosSanidad de Cataluña; Coste-utilidad; Oclusión de grandes vasosIntroduction A direct transfer to angiosuite (DTAS) protocol has shown to be effective and safe by shortening in-hospital workflows and encouraging long-term outcome benefits. To implement DTAS at a new facility, a large organizational effort is necessary. We performed a cost-utility analysis and budget impact analysis (BIA) of the operation of a new angiosuite, primarily dedicated to stroke patients, that allows facilities to approximate the cost implications of utilizing a DTAS pathway. Methods Sixty-one patients who underwent endovascular treatment (EVT) following DTAS were matched for baseline variables to 117 patients who underwent a conventional imaging protocol at a hospital in Catalonia, Spain. An economic model, based on actual data from these patients, was developed to assess the short- and long-term clinical and economic implications of DTAS. In the BIA, the DTAS scenario was gradually implemented for 20% of patients each year until reaching a plateau at 80% of patients in the DTAS pathway. Initial investment and additional organizational costs, €4 million, were taken into consideration to compare the budget impact of the DTAS scenario with no organizational changes over five years. Results DTAS was associated with better patient functional independence rates (mRS 0–2: 50.9% vs. 41.0%) and a quality-adjusted life-years gain of 0.82 per patient. Despite the additional initial investment, DTAS development was associated with an estimated 10.2% reduction (€14.7 million) of the total costs (€144.5 million). Cost savings were mainly due to long-term associated costs related to patient disability (€13.2 million). Limitations The study relies on data obtained from a single-center, and therefore it may be difficult to generalize the findings Conclusions Our economic model predicts that the implementation of a DTAS program is cost-effective compared with no organizational changes. Our model also predicts better clinical outcomes for patients in terms of functional independence and quality-adjusted life years.This study was sponsored by Medtronic

LA PATAGONIA ORIENTAL SEGÚN UNA REAL CÉDULA de 1570 MENOSPRECIADA POR LA HISTORIOGRAFÍA CHILENA

Versa este trabajo sobre la Real Cédula de Felipe II que, en 1570, fusionó parte de la Patagonia Oriental con la Provincia del Río de la Plata, origen de la República Argentina, donde, al parecer, supieron del documento treinta años después de finalizado el debate con Chile acerca de los derechos al extremo meridional de América. Descubierta por un diplomático chileno, que informó de ella a su Cancillería en 1876 y la mencionó en un libro publicado en 1903, ha sido sistemáticamente ignorada por los escritores chilenos. Examina este trabajo las posibles causas de ese silencio historiográfico, como también las rectificaciones que la RC introduce en la tesis clásica o fundacional de Chile, formulada a mediados del XIX por Miguel Luis Amunátegui, según la cual ese país siempre ejerció jurisdicción sobre la totalidad de la Patagonia Oriental desde 1554<br>This work deals with a 1570 Phillip the II Decree that fused a section of Atlantic Patagonia with the Rio de la Plata Province, origin of late Argentine Republic, who, apparently, learned about it thirty years after ended the discussion held with Chile in respect the rights of each country towards the southern extreme of America. Found by a chilean diplomat, who informed his Ministry of Foreign Affairs in 1876 and wrote about the document in a book published in 1903, it has been systematically ignored by chilean scholars. The work examines the possible causes for this historiographyc silence, and the rectifications that the Royal Decree introduces in the classical chilean thesis about Patagonia, enounced by Miguel Luis Amunategui in middle XIX century, according to which that whole territory always belonged to Chile since 155