The analysis of the costs of the Stroke Unit of the Vall d’Hebron University Hospital shows that the ‘direct to angiography room’ approach can save more than 2,800 euros per patient, in addition to improvements in clinical results
AMSTERDAM, June 14.
Royal Philips, a world leader in healthcare technology, today announced the publication in the Journal of NeuroInterventional Surgery (JNIS) of the results of an economic analysis showing that the innovative ‘direct to ward’ approach reduces the costs of stroke care. at an average of 2,848 euros (3,120 dollars) per patient. The retrospective analysis was based on data from the ANGIOCAT single-center controlled clinical trial, carried out by the Stroke Unit of the Hospital Universitari Vall d’Hebron in Barcelona [1]. Previous results from this study have already shown that the ‘direct to ward’ approach improves the clinical outcomes of patients who have suffered a stroke.
“The ANGIOCAT clinical trial has already shown that moving stroke patients directly to the angiography suite improves clinical outcomes. Now this economic analysis tells us that we can also significantly reduce the costs of care,” said Dr Manuel Requena, neurologist specialist in stroke and interventional neurologist at Hospital Universitari Vall d’Hebron. “This indicates that the initial investment in a direct workflow to the angiography room translates into a rapid return on investment for healthcare providers.”
Innovation in stroke care
After the initial triage in the emergency room, the traditional route of care for stroke patients involves sending the patient to the radiology service for a diagnosis by computed tomography (CT) or magnetic resonance imaging. These explorations require time, which can be increased by communication failures between professionals or difficulties in accessing experts. For stroke units, a faster alternative is to have a 24-hour operating angiography room to which patients can be transferred immediately upon admission.
Using cone beam computed tomography (CBCT) technology, such as that integrated into Philips’ Azurion image-guided therapy system, clinicians can diagnose and intervene on stroke place, thus saving valuable time. The cost-effectiveness analysis further indicates that a return on investment in a dedicated stroke angiography suite can be achieved in just a few years.
cone beam computed tomography
Philips’ ‘direct to room’ strategy is based on the use of Cone Beam Computed Tomography (CBCT) examinations performed directly in the angiography room. This technology uses a cone-shaped X-ray beam and a flat panel detector mounted in a C-arm similar to that commonly used in angiography suites. This allows multiple images to be captured from different angles to reconstruct a 3D model of the patient’s brain.
Thanks to technological advances, Philips has improved the accuracy of CBCT diagnosis from 32% to 93% in a few years [3][4][5]. With this technology, intracranial hematomas can be ruled out and large blood vessel occlusions can be identified, which are responsible for between a quarter and a half of acute ischemic strokes [2]. Patients diagnosed with a large vessel occlusion can immediately undergo a minimally invasive procedure known as a thrombectomy to unblock the artery that is causing the stroke.
Lower cost and better clinical results
Different single center trials have demonstrated the positive impact of the ‘direct to ward’ approach on clinical outcomes, which has motivated many stroke units to adopt it. Several medical centers, including the Vall d’Hebron University Hospital, are currently participating in a large, multicenter, randomized clinical trial called WE-TRUST (Workflow Optimization to Reduce Time to Endovascular Reperfusion for Ultra-fast Stroke Treatment) whose objective is to confirm the benefit for patients in the ‘direct to ward’ strategy [8].
Philips’ proposals in stroke include solutions for monitoring and communication of patients in ambulances, remote evaluation, analysis and diagnosis by image, image-guided therapy, and neurological monitoring and evaluation, among others. Its image-guided therapy solutions are based on the Azurion platform.
References:
[1] Requena M, Vanden Bavière H, Verma S, et al. Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial. Journal of NeuroInterventional Surgery Published Online First: 27 April 2023. doi: 10.1136/jnis-2023-020275
[2] World Stroke Organization (WSO): Global Stroke Fact Sheet 2022 (https://www.world-stroke.org/assets/downloads/WSO_Global_Stroke_Fact_Sheet.pdf)
[3] Nicholson P, Cancelliere NM, Bracken J, et al. Novel flat-panel cone-beam CT compared to multi-detector CT for assessment of acute ischemic stroke: A prospective study. Eur J Radiol. 2021 May;138:109645. doi: 10.1016/j.ejrad.2021.109645. Epub 2021 Mar 10. PMID: 33725654.
[4] Cancelliere NM, Hummel E, van Nijnatten F, et al. The butterfly effect: improving brain cone-beam CT image artifacts for stroke assessment using a novel dual-axis trajectory. J Neurointerv Surg. 2023 Mar;15(3):283-287. doi: 10.1136/neurintsurg-2021-018553. Epub 2022 Apr 27. PMID: 35478176; PMCID: PMC9985729.
[5] Cancelliere NM, van Nijnatten F, Hummel E, et al. Motion artifact correction for cone beam CT stroke imaging: a prospective series. J Neurointerv Surg. 2022 Dec 23:neurintsurg-2021-018201. doi: 10.1136/jnis-2021-018201. Epub ahead of print. PMID: 36564201.
[6] WE-TRUST. Workflow optimization to reduce time to endovascular reperfusion for ultra-fast stroke treatment, ClinicalTrials. gov, U.S. National Library of Medicine, identifier: NCT04701684. n.d. Available: https://clinicaltrials.gov/ct2/show/ NCT04701684. The WE-TRUST study is sponsored by Philips.
About Royal Philips
Royal Philips (NYSE: PHG, AEX: PHI) is a leading healthcare technology company focused on improving people’s health and well-being, and facilitating better outcomes across the health cycle, from habits health and prevention, to diagnosis, treatment and home care. Philips draws on its advanced technology and in-depth clinical and consumer insights to offer integrated solutions. Headquartered in the Netherlands, the company is a leader in diagnostic imaging, image-guided therapy, patient monitoring and health informatics, as well as consumer health and home care. Philips has recorded sales of €17.8 billion in 2022 and employs approximately 74,000 employees, with business operations and services in more than 100 countries. All Philips news is in our News Center.
Contact: César García Requena, Brand
