A case management intervention in stroke care: Evaluation of a quasi-experimental study

Duevel, Juliane Andrea; Elkenkamp, Svenja; Gensorowsky, Daniel; Brinkmeier, Michael; Galle, Georg; Miethe, Johannes; Greiner, Wolfgang

doi:10.1016/j.zefq.2024.03.008

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…The majority of patients were diagnosed using imaging techniques during the index stay, and only a small proportion initially required treatment in an intensive care unit using mechanical ventilation or a gastric tube. Details can be seen in [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…For the total study population (all stroke patients), the direct costs were significantly higher in the intervention group than in the control group, with a difference of EUR 1384.78 in the regression analysis (β = 0.2802, exp(β) = 1.3234, 95% CI: [1.2384–1.4143], p < 0.0001). Additionally, a 5.32% increase in hazards was observed for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) [ 43 ]. This resulted in an incremental cost-effectiveness ratio (ICER) of EUR 260.30 per percentage point increase in hazards, indicating that the intervention was dominated (i.e., more costly and less effective).…”

Section: Resultsmentioning

confidence: 99%

“…In the subgroup of TIA patients, the intervention group incurred costs that were EUR 231.17 higher than those of the control group (β = 0.2381, exp(β) = 1.2688, 95% CI: [1.0796–1.4912], p = 0.004), and the intervention had a non-significant protective effect in terms of the risk of recurrence (HR = 0.1563, 95% CI: [0.0216–1.1324], p = 0.0662). Therefore, with reference to the ICER for this subgroup, there was a EUR 2.74 per percentage point reduction in HR [ 43 ].…”

Section: Resultsmentioning

confidence: 99%

“…However, 36 patients died in the intervention group and 46 in the control group (3.1% vs. 3.9%; HR: 0.86; 95% CI: [0.58–1.28], p = 0.46). Hence, the mortality rate in both groups was low, and the difference observed was not significant, making an impact on the costs incurred rather unlikely [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…This result aligns with the literature on case management approaches, which usually focus on severe cases [ 44 ]. In contrast, the STROKE OWL study excluded the most severe cases of stroke (mRS > 5) and included only a small number of severe cases (mRS = 4) [ 43 ]. This suggests that a case management intervention focused on more severe cases of stroke may be more cost-effective.…”

Section: Discussionmentioning

confidence: 99%

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Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Duevel,

Gruhn,

Grosser

et al. 2024

Healthcare

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Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0–4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384–1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Duevel,

Gruhn,

Grosser

et al. 2024

Healthcare

Self Cite

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Prädiktoren für die Folgen eines Schlaganfalls: eine systematische Literaturübersicht für GKV-Routinedatenanalysen

Aufenberg,

Düvel,

Morthorst

et al. 2024

Gesundheitsökonomie & Qualitätsmanagement

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Zusammenfassung Zielsetzung Ermittlung unabhängiger Variablen (UVs) des Schlaganfallrezidivs, der Mortalität und der Kosten nach Schlaganfall oder transitorisch-ischämischer Attacke, abbildbar in Routinedaten der Gesetzlichen Krankenversicherung. Methodik Durchführung einer systematischen Literaturrecherche in PubMed und Embase unter Anwendung festgelegter Auswahlkriterien. Ergebnisse Von 1 982 Treffern wurden 23 eingeschlossen. Robuste UVs für Rezidiv und Mortalität waren Alter, Schlaganfalltyp, Diabetes mellitus und Vorhofflimmern. Bei Mortalität waren zudem Geschlecht, stationärer Aufnahmezeitpunkt und Stroke Unit-Behandlung relevant. Für Kosten war die Evidenzlage zu gering. Schlussfolgerung Eine Übersicht zu UVs des Rezidivs und der Mortalität wurde gegeben. Folgestudien sollten einheitliche Ansätze hinsichtlich Schlaganfall- und Outcomedefinitionen sowie Evaluationszeiträumen wählen.

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Identification of a suitable matching procedure in health services research: Insights into a study for stroke patients

Elkenkamp,

Düvel,

Gensorowsky

et al. 2024

Research Methods in Medicine & Health Sciences

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Background STROKE OWL is a quasi-experimental study using claims data from statutory health insurances in Germany to calculate the effect of case managers for stroke. Since there is no recruited control group, a suitable procedure needed to be identified to make the intervention effect measurable. Hence, the objective of this paper is to present an approach for comparing matching procedures before final data analyses take place. Methods We followed a four-step approach to identify an appropriate procedure on a partial dataset. First, we conducted a systematic review for identifying potential confounders of the study’s outcome. Afterwards we checked whether a matching procedure was able to balance the dataset with respect to the outcome, under the assumption that all relevant covariates including the intervention variable were balanced. Within the two last steps we checked covariate balances and remaining group sizes. Three matching procedures – coarsened exact matching, optimal full matching and propensity score matching – were tested. Results The coarsened exact matching was able to balance variables perfectly but on average lost >50% of the observations. Although optimal full and propensity score matching revealed some weaknesses concerning the variable balance, considerably more observations remained in the dataset. Based on the described approach and the external framework conditions of STROKE OWL the optimal full matching was chosen as matching procedure most suitable. Conclusion In summary, it was challenging to identify a suitable matching procedure for this study, since the detailed results of the different balance and group size checks varied.

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A case management intervention in stroke care: Evaluation of a quasi-experimental study

Cited by 5 publications

References 27 publications

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Prädiktoren für die Folgen eines Schlaganfalls: eine systematische Literaturübersicht für GKV-Routinedatenanalysen

Identification of a suitable matching procedure in health services research: Insights into a study for stroke patients

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