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.
Highlights
Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost
In 20 years, the prevalence of stroke in the Netherlands will be more than 40% higher as a result of aging of the population, continuing unhealthy lifestyles among elderly, and improved care for stroke patients leading to lower mortality [1]
Niessen et al [5] estimated future stroke morbidity rates using a disability-based two-state transition model combining population projections and existing data on stroke epidemiology. Their projections indicated that the aging of the population and the increase in cardiovascular survival would partially mitigate the effect of the declining incidence on the total burden of stroke, leading to a further increase in major stroke prevalence among the oldest age groups
Summary
Economic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. In The Netherlands, as in most Western countries, stroke is a major contributor to the total burden of disease, in terms of morbidity, mortality and concomitant costs. Niessen et al [5] estimated future stroke morbidity rates using a disability-based two-state transition model combining population projections and existing data on stroke epidemiology. Their projections indicated that the aging of the population and the increase in cardiovascular survival would partially mitigate the effect of the declining incidence on the total burden of stroke, leading to a further increase in major stroke prevalence among the oldest age groups
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