Education And Debate

Controversies in Management: Costs outweigh benefits

BMJ 1994; 309 doi: (Published 03 December 1994) Cite this as: BMJ 1994;309:1499
  1. S P Allison, consultant physiciana
  1. a University Hospital, Nottingham NG7 2UH


    In Britain 100 000 strokes occur annually, and patients with stroke occupy a fifth of all medical and a quarter of all long term beds as well as consuming 5% of the NHS budget. At present half of all acute strokes are managed by general practitioners at home. Last year 891 patients were admitted to the University Hospital, Nottingham, with a diagnosis of stroke; 210 had computed tomography at a cost of £80 per head. If computed tomography of all patients with stroke became mandatory the first effect would be to double the admission rate to include all those currently managed at home. The additional cost of scanning these and the rest of the 891 patients admitted would be roughly £125000 a year without the costs of admitting 800 more medical patients. The medicolegal consequences of making computed tomography mandatory in all stroke patients are easily imagined. Computed tomography for stroke must be proved to be extremely effective for such a cost to be justified. I believe that the case has yet to be made.

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