What is the optimal model of service delivery in Transient Ischaemic Attack?

[摘要] Transient Ischaemic Attack (TIA) is associated with a high early risk of stroke which can be considerably reduced by early initiation of secondary preventive drugs including antiplatelets, statins and blood pressure lowering therapy. These treatments are usually initiated by a specialist after urgent out-patient review. However, variable access to timely specialist services means that initiation of these treatments is delayed for some patients. The purpose of this thesis was to evaluate the cost-effectiveness of GP initiation of treatment following a suspected TIA compared with UK clinical practice. A Markov model was constructed to model the cost and effectiveness of urgent initiation of treatment following suspected diagnosis of TIA by GPs. In the base-case, GP initiation of treatment (followed by specialist review of treatments within a week) was compared with best practice, as stated in the National Stroke Strategy (2007). Strategies involving same-day GP initiation of treatment was found to be highly cost-effective at willingness to pay thresholds typically applied in the UK. This study illustrates the usefulness of modelling techniques to use secondary data sources to examine a policy relevant question around treatment urgency in a susceptible and identifiable group of patients where primary research is impracticable.

[发布机构] University:University of Birmingham;Department:School of Health and Population Sciences, Primary Care Clinical Sciences

[关键词] R Medicine;R Medicine (General)