Original Title: Variaciones, desigualdades, grado de uso inapropiado y costes evitables de pruebas por imagen en el diagnóstico y seguimiento de los pacientes con ictus en Canarias

Authors' objectives: To determine the possible variations and inequalities in access and implementation of diagnostic imaging tests in patients with stroke. Other objectives are to determine the degree of inappropriate use of imaging and its consequent avoidable costs in hospitals in the region of Canary Islands.

Authors' results and conclusions: RESULTS: The results showed that for patients with established stroke, higher Charlson comorbidity index and younger age increase the chance of receiving an MRI. By contrast, factors that decrease the accessibility of this test image are features such as being male or having a CT scan done before. However, for patients with TIA, age is the only one factor that determines the access to MRI. In terms of variations in the use of MRI and CT over the years, the results showed a slight increase in the use of MRI in recent years, both for established stroke patients and patients with TIA. Although some peaks of variation, this behavior was similar in the four referral hospitals in the Canary Islands. As for the results on the avoidable costs of imaging, we obtained an avoidable cost of 0.27% of total estimated expenditure generated by stroke patients in imaging tests in the participating hospitals. CONCLUSIONS: According to the guidelines, all patients who suffer a stroke, either established or temporary, should undergo a brain imaging test. There are not clear advantages of MRI compared with CT or vice versa. So the variations we found in the use of both tests are remarkable. However, in a conservative scenario, only 0.3% of total expenditure attributable to neuroimaging in patients with stroke could be avoided.

Authors' methods: 1. To evaluate the variations and inequalities in access to imaging tests of stroke patients in hospitals in the Canary Islands, we followed the next steps: • Data on patients admitted with a diagnosis of stroke established or TIA were extracted from the CMBD during the period 2005- 2010. • Trends of the use of MRI and CT of the diagnosis and clinical management of stroke in recent years were analyzed. • Inequalities in access to imaging tests were analyzed by the implementation of logistic regression models. 2. To determine the number of imaging tests that are not supported by sufficient scientific studies of effectiveness (misuse), and the consequents avoidable costs, we followed the next stages: • Data on inpatients with a diagnosis of stroke established or TIA were extracted from databases for routine hospital use during 2010. The information about imaging tests was extracted of these databases. • Clinical Practice Guidelines (CPG) on this issue was researched and retrieved from electronic databases. • Quality assessment for identified CPG were carried out by means of the AGREE instrument. • Information from the databases was classified according to their scientific evidence in appropriate and inappropriate. • Avoidable costs of imaging tests classified as inappropriate were estimated.

Project Status: Completed

Year Published: 2011

URL for published report: https://sescs.es/estudio-de-pruebas-por-imagen-en-el-diagnostico-y-seguimiento-de-los-pacientes-con-ictus-en-canarias/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Spain

Organisation Name: Canary Health Service

Contact Address: Dirección del Servicio. Servicio Canario de la Salud, Camino Candelaria 44, 1ª planta, 38109 El Rosario, Santa Cruz de Tenerife

Contact Name: sescs@sescs.es

Contact Email: sescs@sescs.es