Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

Abstract

BackgroundEconomic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting.MethodsThe EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients) to usual care (n = 187 patients). Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D), transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm.ResultsLifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75) for male patients in usual care and 2.75 (-0.61; 6.26) for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837) and €42,944 (14,081; 95,944) for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively). This stroke service is with 90% certainty cost-effective.ConclusionsOur analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.

Real-life costs and effects of an implementation program to increase thrombolysis in stroke

“…16,17 These tables allow for occurrence of discrete events in 6 months' time steps-recurrent strokes, stroke deaths, deaths from ischemic heart disease, and deaths from other causes-in a cohort of stroke patients (figure 1). The stroke states include 4 disability mRS categories and death.…”

“…The stroke states include 4 disability mRS categories and death. 17 We entered the individual patient-level 3 months trial data on stroke severity, health care costs, and health-related quality of life into the life tables in a probabilistic bootstrap way, allowing for multiple draws per patient (Microsoft Excel add-in: Palisade's @Risk 4.5). In each iteration we drew one patient randomly from the intervention group simultaneously with a randomly selected patient from the control group, matched by age, gender, and initial stroke severity.…”

Cost Effectiveness of Long-Term Incobotulinumtoxin-A Treatment in the Management of Post-stroke Spasticity of the Upper Limb from the Australian Payer Perspective

“…The management of moderate to severe PSS-UL can be resource-intensive and the maintained functional ability through ongoing treatment could provide cost savings to the healthcare system. Observational data reported by Baeten et al [23] and Lundstrom et al [24] have suggested the extent of this potential cost saving is more substantial. A detailed analysis of the resource utilisation and costs of PSS-UL in patients with and without response to treatment would further improve the reliability and applicability of these results.…”

Dabigatran for the Treatment and Secondary Prevention of Venous Thromboembolism; A Cost-Effectiveness Analysis for the Netherlands

“…Utility decrements following the occurrence of other adverse events (i.e. MI, UA, dyspepsia, disabled from ICH, CTEPH, and severe PTS) were derived from the published studies and applied additively for a specific time interval in the model [ 6 , 21 – 25 ].…”