Ariste, R.

Friesen, D.

Hakkinen, U.

Jacobs, P.

Jeerakathil, T.

Kaul, P.

Klarenbach, S.

Ohinmaa, A.

Ruseski, J.

Thanh, N.X.

Zheng, Y.

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A502  VA L U E  I N  H E A LT H  1 7  ( 2 0 1 4 )  A 3 2 3 – A 6 8 6  
status. Methods: New ischemic stroke (ICD-10 code I63) patients (no previous 
stroke within one year) between April 1, 2006 and March 31, 2009 (N= 4,350) were 
followed for one year using hospital Discharge Abstract Database. The severity of 
the stroke was obtained from the ambulatory care database. Median hospital costs 
by CMG+ group were obtained from Alberta Health. Hospitals were classified as 
teaching, community large, community medium, and community small hospitals. 
Hospitals were also classified as comprehensive stroke centre, urban and rural 
primary stroke centres, and other urban and rural hospitals. The adjusted risk 
factors in Bayesian Model included sex, age, all disease-specific co-morbidities, 
and disease severity. The results for four hospital types and five stroke center cat-
egories were calculated using the observed/expected approach. Results: The 30 
days mortality rates (95% CI) were lowest for teaching hospitals 10.1% (9.0%-11.2%) 
and large community hospitals (10.0%; 8.3%-11.8%), and the small community 
hospitals had the highest mortality rates (12.8%; 9.9%-15.8%). The mean LOS (95% 
CI) varied from 21.7 (20.9-22.6) days in teaching hospitals to 34.2 (28.6-41.0) days 
in community medium hospitals. The community medium hospitals had signifi-
cantly higher costs ($62,400; $49,900-$78,000) than the community large hospitals 
($32,900; $29,900-$36,200) and teaching hospitals ($37,000; $34,900-$39,200). Both 
comprehensive stroke and urban stroke centers had lower 30 day mortality rates 
(95% CI): 9.9% (8.8%-11.1%) and 9.7% (7.3%-12.0%); shorter LOS 21.6 (20.7-22.5) 
and 25.0 (22.7-27.6) days; and medium levels of costs $39,300 ($36,100-$40,700), 
compared to other hospitals. ConClusions: The study shows the hospital type 
and stroke centre had limited effects on the mortality but significant impact on 
LOS and costs.
PCV171
In-PatIent HosPItal Costs of stroke: a foCused lIterature reVIew
Kritikou P.1, Vemmos K.2, Payne K.A.3
1United BioSource Corporation, London, UK, 2Acute Stroke Unit, Department of Clinical 
Therapeutics, University of Athens, Athens, Greece,, 3United BioSource Corporation, Dorval, QC, 
Canada
objeCtives: Stroke is the third leading cause of mortality worldwide, with sig-
nificant associated acute care hospitalization costs. The objective of this literature 
review was to delineate the costing methodologies employed for the estimation of 
in-patient hospital costs of stroke. Methods: A PubMed search was performed 
using the keywords: hospitalization, cost analysis, acute stroke, and cost-effec-
tiveness; limited to publications in English from 2008 onwards. Inclusion criteria 
were patient-level data collection and detailed description of costing methodology 
applied. Cost-effectiveness and literature review studies were excluded. Results: 
In total 22 articles were included in the analysis. Cohort studies comprised 45% of 
the sample, followed by database analyses (32%), registered-based studies (9%), 
retrospective chart review studies (9%), and clinical trials (5%). Cost categories 
measured included direct medical costs (bed and staff, laboratory and imaging 
investigations, medications, rehabilitation and supportive nursing care), as well 
as indirect costs for the patients and their caregivers; in 2 studies the economic 
analysis was performed from a societal perspective. The resource utilization 
(excluding the database analyses) was identified in the medical records (80%), or 
from interviews (20%). Unit costs were primarily derived from national listings or 
hospital accounting files (36% each). The sample sizes (ranging from 100 to over 
60,000 patients), as well as the total costs (ranging from US$500 to US$150,000 per 
patient and from US$70 to US$13,000 per day) varied significantly, as a result of the 
heterogeneous cost variables described. ConClusions: Methodologies differed 
in approach, complexity and specific cost variables evaluated. Consequently, the 
total costs varied significantly across studies which makes direct comparisons of 
outcomes difficult. A trend towards more sophisticated economic analyses, such 
as real costs measured versus hospital reimbursement rates, or hospitalization 
costs before versus after stroke, was observed. A more standardized approach to 
evaluating in-patient costs of stroke care is warranted.
PCV172
oPtImIzIng ProCess effICIenCy tHrougH ImPlantIng reVeal lInq 
Versus reVeal Xt/dX from tHree sPanIsH HosPItal PersPeCtIVe
Egea García M.1, Toquero Ramos J.2, García Alberola A.3, Arias Palomares M.Á.4, Marti 
Sánchez B.1
1Medtronic Iberia, Madrid, Spain, 2Hospital Puerta de Hierro, Majadahonda, Spain, 3Hospital 
universitario Virgen de la Arrixaca, Murcia, Spain, 4Hospital Virgen de la Salud, Toledo, Spain
objeCtives: Implantable loop recorders (ILR) are devices that continuously moni-
tor heart rhythm in patients with suspicion of cardiac arrhythmias. Reveal LinQ™ 
is a new insertable holter, an 87% smaller than Reveal® XT/DX that records abnor-
mal heart rhythm up to 3 years. The objective was to develop an economic tool 
which allows hospitals to quantify their cost savings from the simplified procedure 
of Reveal LinQ™. The tool was used to compare the costs of implanting Reveal® 
XT/DX in the cath lab to the costs of inserting Reveal LinQ™ out of the cath lab in 
three public hospitals of the Spanish National Health Care System. Methods: A 
cost model was developed to assess the cost per procedure of Reveal LinQ™ and 
Reveal® XT/DX. The model included data of the personnel needed in the proce-
dure, the hospital setting, the hospitalization previous to the procedure, remote 
monitoring and post-procedure controls. Results: The total process-related 
savings of LinQ™ vs. Reveal® XT/DX in Virgen de la Salud, Puerta de Hierro and 
Virgen de la Arrixaca Hospitals were € 335 (13.3%), € 365 (13.1%) and € 517 (19.2%), 
respectively. Reveal LinQ™ was associated with a 66% reduction in cardiologist 
and OR-assistant time in Virgen de la Salud Hospital, a reduction of 15 minutes 
of cardiologist time in Puerta de Hierro Hospital and a reduction of 3 control vis-
its due to remote monitoring in Virgen de la Arrixaca Hospital. ConClusions: 
The economic tool showed that the insertion of Reveal LinQ™ is associated 
with mean savings of € 406 from a hospital perspective compared to previous 
devices; mainly derived from moving the procedure out of the catheter lab, a 
reduction of the specialists’ time and in-hospital follow up visits due to remote 
monitoring.
in Greece a substantial increase of the households with at least one chronic condi-
tion patient which are subjected to CHE is recorded. There is a need for counter 
measures or/and an alternative policy context in order to reduce this catastrophic 
effect of economic crisis.
PCV167
snaPsHot of PresCrIbIng PraCtICe for CloPIdogrel and esomePrazole 
Co-PresCrIPtIon and Cost eValuatIon of guIdelInes aPPlICatIon
Vernaz N., Rollason V., Adlere L., Bonnabry P., Desmeules J.
University of Geneva Hospitals, Geneva, Switzerland
objeCtives: Through CYP2C19, the antiplatelet clopidogrel and the proton-pump 
inhibitor esomeprazole demonstrate a pharmacokinetic interaction that could 
translate into clinical inefficacy of clopidogrel. No medical consensus has been 
reached to date and therefore different guidelines are available. We aimed to 
evaluate the prescribing practices in the University Hospitals of Geneva (HUG) by 
measuring if the co-prescription was staggered as suggested by experts. We also 
measured the Omeprazole-CLopidogrel-Aspirin (OCLA) study impact on clopi-
dogrel use in our hospital. Methods: Patient’s medical orders and nurse’s drug 
administration planning’s were analysed from January 2013 to April 2014 and the 
hospital pharmacy database from January 2000 to April 2014. To measure the “extra 
costs” of the implementation of different guidelines we built scenarios assum-
ing the clopidogrel or esomeprazole replacement with prasugrel or ticagrelor 
and pantozole or ranitidine, respectively. Results: Fifty seven percent of patients 
under clopidogrel had a co-prescription of esomeprazole during the study period. 
Among them 15% (154/1’000) had a medical order staggering the co-prescription 
(more than 10 hours apart), 16% a concomitant prescription and 64% no clear 
information. Five percent had 40 mg esomeprazole twice daily, hindering the 
possibility of staggering. Surprisingly we found a higher rate of patients hav-
ing a nurse’s schedule of more than 10 hours (39%, 417/1’071). Switching drugs 
would lead to increased costs for HUG of € 38’210 for prasugrel, € 34’800 for tica-
grelor, € 9’590 for pantoprazole and € 5’205 for ranitidine. A statistical significant 
decrease in trend of clopidogrel use was observed after the OCLA study publi-
cation. ConClusions: The medical order’s information time frame should be 
mandatory in order to improve the transmission throughout the whole informa-
tion system and allow a clear staggering of clopidogrel-esomperazole co-prescrip-
tion avoiding drug-drug interactions when possible. Nurses take the initiative 
to stagger the co-prescription when these are not clearly defined by medical 
orders.
PCV168
regIonal VarIatIon In HosPItal mortalIty, lengtH of stay and Cost 
of IsCHemIC stroke PatIents In alberta
Ohinmaa A.1, Zheng Y.2, Jeerakathil T.1, Thanh N.X.2, Hakkinen U.3, Kaul P.1, Klarenbach S.1, 
Friesen D.4, Ariste R.5, Ruseski J.6, Jacobs P.2
1University of Alberta, Edmonton, AB, Canada, 2Institute of Health Economics, Edmonton, 
AB, Canada, 3National Institute for Health and Welfare, Helsinki, Finland, 4Alberta Medical 
Association, Edmonton, AB, Canada, 5Canadian Institute for Health Information, Ottawa, ON, 
Canada, 6West Virginia University, Morgantown, WV, USA
objeCtives: This study compares the outcome and health care performance 
among five health zones in Alberta by evaluating 30 days in-hospital mortality 
and length of stay (LOS) in patients with acute ischemic stroke, and total hospitali-
zation costs over one year. Methods: Ischemic stroke (ICD-10 code I63) patients 
(without previous stroke within one year, N= 1,445) hospitalized between April 
1, 2007 and March 31, 2008 were followed for one year using hospital Discharge 
Abstract Database. The severity of the stroke was obtained from the ambulatory 
care database (NACRs). Median hospital costs by CMG+ group were obtained from 
Alberta Health. Logistic regression was used to analyse in-hospital mortality; nega-
tive binomial regression assessed LOS, and generalized gamma model (log link) 
for hospital costs. The risk-adjusted outputs were estimated adjusting for sex, 
all disease-specific co-morbidities, and stroke severity. We calculated observed/
expected results for five zones; South, Calgary, Central, Edmonton, and North 
Zones. Results: The risk-adjusted 30-days-mortality rates (95% CI) varied from 
7.8% (3.4%-12.1%) to 13.5% (9.6%-17.4%) in South and Central zones, respectively. 
The adjusted mean LOS varied from 16.3 (13.8-19.3) days in South Zone to 26.7 
(24.2-29.5) and 29.3 (24.0-35.8) days in Edmonton and North zones, respectively. The 
results show several statistically significant differences between the first episodes 
LOS between zones reflecting partly differences in the post-acute care in each loca-
tion for patients not discharged to home. The one-year-mean hospitalization costs 
varied from $72,300 ($55,000-$95,100) in North Zone to $25,500 ($20,500-$31,800) in 
South Zone. ConClusions: The study shows significant variation in outcomes 
for ischemic stroke between the five health zones. Although the Provincial Stroke 
Strategy has largely standardized the stroke care between regions, differences in 
post-acute care arrangements have produced significant LOS and cost differences. 
More detailed analysis of the reasons for regional variation is needed for improve-
ment of the regional health care outcomes.
PCV170
tHe assoCIatIon of HosPtIal tyPe and stroke Centre wItH  
mortalIty, lengtH of stay and HosPItal Cost of IsCHemIC stroke 
PatIents In alberta
Ohinmaa A.1, Zheng Y.2, Jeerakathil T.1, Thanh N.X.2, Hakkinen U.3, Ruseski J.4, Kaul P.1, 
Klarenbach S.1, Friesen D.5, Ariste R.6, Jacobs P.2
1University of Alberta, Edmonton, AB, Canada, 2Institute of Health Economics, Edmonton, AB, 
Canada, 3National Institute for Health and Welfare, Helsinki, Finland, 4West Virginia University, 
Morgantown, WV, USA, 5Alberta Medical Association, Edmonton, AB, Canada, 6Canadian 
Institute for Health Information, Ottawa, ON, Canada
objeCtives: This study examines the association of 30 day in-hospital mortality, 
length of stay (LOS) during the first hospital episode, and hospitalization costs 
during one year after acute ischemic stroke by type of hospital and by stroke centre 


PCV170 The Association of Hosptial Type and Stroke Centre With Mortality, Length of Stay and Hospital Cost of Ischemic Stroke Patients in Alberta 

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PCV170 The Association of Hosptial Type and Stroke Centre With Mortality, Length of Stay and Hospital Cost of Ischemic Stroke Patients in Alberta

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