1. Stroke Health Economics Project A new NHS resource for data on the health and social care costs of stroke Dr Benjamin Bray

2. The vision
Make use of the richness of data available on stroke care in the NHS
Base cost estimates on individual patient characteristics – getting deeper insights than simple averages
Interactive tools to explore the costs and benefits of implementing interventions with a strong evidence base: early supported discharge and thrombolysis
Creating synergies by integrating cost data into routine SSNAP outputs

3. SSNAP
Ischaemic stroke
Primary ICH
≈ 80,000 per year
Whole pathway care quality: from admission, up to 6 months after stroke
Data, analysis, visualisations every 3 months designed for:
Teams
CCGs
Clinical networks
Stroke survivors
National level reports
All acute admitting hospitals in England
Organisational audits of acute and post acute care services

4. Building a new health economic engine into SSNAP
Ischaemic stroke
Primary ICH
≈ 80,000 per year
Whole pathway care quality: from admission, up to 6 months after stroke
Data, analysis, visualisations every 3 months designed for:
Teams
CCGs
Clinical networks
Stroke survivors
National level reports
All acute admitting hospitals in England
Whole pathway level health and social care costs of stroke
Organisational audits of acute and post acute care services

5. What does the model produce?
Patient level estimates in categories of:
Age
Sex
Stroke type
Stroke severity
(80 different combinations)
Outcomes:
NHS and social care costs
Total length of inpatient stay
QALYs
Interactive tools to model cost/benefit of:
Early supported discharge
Thrombolysis
Age
Sex
Stroke type
Stroke severity
NHS costs – 1 year
NHS costs – 5 year
Social care costs – 1 year
Social care costs – 5 year 80
Female
ICH
Severe
£XXXXX
e.g.
∑ Add up to produce estimates for any cohort of patients

6. Headline results
≈ people are admitted to hospital with stroke each The total costs attributable to stroke in people with a acute stroke per year :
NHS
Social Care
NHS & Social Care
1 year
£1.03 billion
£633 million
£1.66 billion
5 year
£1.40 billion
£2.05 billion
£3.45 billion
NHS: Hospital admission, rehabilitation, GP attendances, prescribing
Social Care: Care home admission, packages of care (Note issues of “who pays” for care)

7. Previous cost estimates have been averages
£23,000 over 10 years

8. ...but the new model allows us to understand costs in a much more detailed way
Each dot represents a single patient with stroke (n=80000)

9. ...and can be used for new analyses such as identifying the costs of potentially avoidable stroke
The blue dots are patients with AF

10. Data sources SSNAP was the major data resource
April March 2015
Patients were stratified to sub-groups
South London Stroke Registry (SLSR) was used for longer term data including survival and resource use
Cost data was obtained from standard NHS sources
NHS reference costs
Personal Social Services Research Unit
Quality of life weights: EQ-5D scores were mapped from Modified Rankin Scale (mRS) using an equation from Whynes et al 2013
Whynes, D.K., et al., Testing for differential item functioning within the EQ-5D. Medical Decision Making, 2012: p X

11. Patient pathway Acute stroke care Rehabilitation Longer term care
Ambulance
Brain scan
Acute stroke unit
Thrombolysis
Rehabilitation
Inpatient rehabilitation
Early supported discharge
Community rehabilitation
Longer term care GP
Home help
Care home
Other support (e.g. meals on wheels)
Recurrence

12. NHS and social care costs
Results – Current cost
Average costs per patient:
Mean NHS costs
Mean social care cost
NHS and social care costs
Mean QALY
1-year
£13,459
£8,716
£22,175
0.48
5-year
£17,931
£27,301
£45,233
1.63
Explain QALY

13. Results – Current costs
Costs increase with age
Costs of haemorrhage patients are higher than ischaemic patients

14. Summary of results Mean NHS cost per stroke patient
£13,500 in first year
£18,000 over 5 years.
NHS cost savings over 5 years
£4,100 per extra patient thrombolysed
£1,600 per extra patient discharged to ESD
Better health related outcomes over 5 years
0.26 QALYs per extra patient thrombolysed
0.14 QALYs per extra patient discharged to ESD
The results will be used to provide bespoke estimates to SSNAP users

15. How might the data be useful?
Making the case for investing in prevention (AF etc)
Readily available figures (from a source you can reference) to put into business cases for improvement and service development
Keeping stroke on the agenda of policy makers and commissioners
Helping to model financial case for improving access to thrombolysis and ESD

16. Summary
One of the first national quality programmes in the world to integrate patient level cost data alongside data on healthcare quality
We can now estimate health & social care costs from stroke for any geography in England
A new resource for QI, commissioning, transformation and prevention
Potentially could be expanded to other high cost, high burden health conditions

17. NHS England: Project funder
Acknowledgements
NHS England: Project funder
SSNAP: Data and analytics
National Guideline Centre: Health economics
South London Stroke Register: Data
Xiangming Xu National Guideline Centre
David Wonderling National Guideline Centre
Rachel Otago SSNAP
Emma Vestesson SSNAP
Lizz Paley SSNAP
Alex Hoffman SSNAP
Anita Desikan South London Stroke Register
Charles Wolfe South London Stroke Register
Anthony Rudd NHS England & Guy’s and St Thomas Foundation Trust