COMPARISON OF THE USE OF MEDICAL RESOURCES AND OUTCOMES IN THE TREATMENT OF ANEURYSMAL SUBARACHNOID HEMORRHAGE BETWEEN CANADA AND THE UNITED-STATES

Objective-Using data from a randomized trial of tirilazad mesylate, we assessed the differences between Canada and the United States in the use of medical resources and outcomes in the treatment of aneurysmal s ubarachnoid hemorrhage during the first 90 days after admission to the hospital. Methods-Of the 877 patients for whom economic data were ava ilable, 194 were enrolled in Canada and 683 were enrolled in the Unite d States. The differences between the countries in patient characteris tics, use of medical resources, and outcomes were analyzed by comparin g means and the 95% confidence intervals (CIs) around the differences in means. These differences also were predicted with use of multivaria ble regression analysis. Results-The average hospital stay was 4.2 day s longer (95% CI, 1.3 to 7.1 days) in Canada, but most of the extra st ay was among patients admitted to the study in poor neurological condi tion. In general, however, hospital stays in Canada were substantially less intensive. Patients treated in Canada spent 3.7 fewer days (95% CI, 1.2 to 6.1 days) in nursing homes and rehabilitation centers than did patients in the United States. No statistically significant differ ences were seen for Glasgow Outcome Scale score, death, and occurrence of vasospasm. Conclusions-For patients admitted to the study in good neurological condition, the apparent difference in length of stay betw een Canada and the United States was caused by a shift in the sites of formal care rather than to the length of this care. For those admitte d in poor neurological condition, both the length and sites of care di ffered between the two countries. No significant difference in outcome s appeared to justify these differences in the use of medical resource s.