Editorial comment--stroke cost-effectiveness research: are acceptability curves acceptable?

Abstract

In this issue of Stroke , Patel et al examine the cost-effectiveness of 3 different care strategies for patients with moderately disabling stoke: stroke unit care, stroke team care, and domiciliary care.1 The results show that stroke unit care was more effective and more costly than the other 2 competing strategies, and based on the incremental comparison of stroke unit care compared with domiciliary care (stroke team care was dominated because it was less effective and more costly than stroke unit care), stroke unit care costs an additional £64 000 to £136 000 per quality-adjusted life year (QALY) gained. The authors rightly point out several limitations that need to be kept in mind, the most important of which is limited generalizability given the known differences in stroke care patterns across countries. Another important limitation not mentioned is that different methods of eliciting health state preferences yield different estimates of QALYs for equivalent health states, and such differences need to be kept in mind, considering the authors used only the EuroQol (EQ-5D) as a …