Abstract
BackgroundSince stroke survivors are increasingly responsible for managing stroke-related changes in their own health and lifestyle, self-management skills are required. In a recent randomised controlled trial a self-management intervention based on proactive coping action planning (SMI) in comparison with an education-based intervention (EDU) in stroke patients was investigated. However, no relevant treatment effects on the Utrecht Proactive Coping Competence scale (UPCC) and the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-Participation) were found. The current study is a trial-based economic evaluation from a societal perspective comparing the same interventions (SMI versus EDU).MethodsUPCC, USER-Participation and EuroQol (EQ-5D-3 L) and costs were measured at baseline, three, six and twelve months after treatment. For the cost-effectiveness analyses, incremental cost effectiveness ratios (ICERs) were calculated for UPCC and USER-Participation. For the cost-utility analyses the incremental cost utility ratio (ICUR) was expressed in cost per Quality Adjusted Life Years (QALYs). Outcomes were tested by means of AN(C)OVA analyses and costs differences by means of bootstrapping. Bootstrapping, sensitivity analyses and a subgroup analysis were performed to test the robustness of the findings.ResultsOne hundred thirteen stroke patients were included in this study. The mean differences in USER-Participation scores (95%CI:-13.08,-1.61, p-value = .013) were significant different between the two groups, this does not account for UPCC scores (95%CI:-.267, .113, p-value = not significant) and QALYs (p-value = not significant) at 12 months. The average total societal costs were not significantly different (95%CI:€-3380,€7099) for SMI (€17,333) in comparison with EDU (€15,520). Cost-effectiveness analyses showed a mean ICER of 26,514 for the UPCC and 346 for the USER-Participation. Cost-utility analysis resulted in an ICUR of €44,688 per QALY. Assuming a willingness to pay (WTP) threshold of €50,000 per QALY, the probability that SMI will be cost-effective is 52%. Sensitivity analyses and subgroup analysis showed the robustness of the results.ConclusionsSMI is probably not a cost-effective alternative in comparison with EDU. Based on the current results, the value of implementing SMI for a stroke population is debatable. We recommend further exploration of the potential cost-effectiveness of stroke-specific self-management interventions focusing on different underlying mechanisms and using different control treatments.
Highlights
Since stroke survivors are increasingly responsible for managing stroke-related changes in their own health and lifestyle, self-management skills are required
The mean differences in USER-Participation scores (95%CI:-13.08,1.61, p-value = .013) were significant different between the two groups, this does not account for Utrecht Proactive Coping Competence scale (UPCC) scores (95%CI:-.267, .113, p-value = not significant) and Quality adjusted life year (QALY) (p-value = not significant) at 12 months
Design The current study describes an economic evaluation attached to the Restore4Stroke Self-Management Study: a multi-centre randomized controlled trial (RCT) with a two-group parallel design, using a balanced randomization stratified by the participating hospital or rehabilitation centre (1:1 ratio)
Summary
Since stroke survivors are increasingly responsible for managing stroke-related changes in their own health and lifestyle, self-management skills are required. In a recent randomised controlled trial a self-management intervention based on proactive coping action planning (SMI) in comparison with an education-based intervention (EDU) in stroke patients was investigated. The current study is a trial-based economic evaluation from a societal perspective comparing the same interventions (SMI versus EDU). The growing demand for stroke care in combination with limited healthcare resources, has led, in the past few years, to an increased interest into the economic aspects of stroke [1]. Forty four percent of this amount is related to direct health care costs e.g. in-hospital care (77%) [2]. Indirect medical costs like informal care costs were estimated at €15.9 billion (35%) and productivity losses €5.4 billion (12%) of stroke in the EU in 2015 [2]
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