Research
Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach
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* Corresponding author: Louis W Niessen lniessen@jhsph.edu
1 Netherlands Institute for Health Sciences, PO Box 2040, 3000 CA Rotterdam, The Netherlands
2 Erasmus University, Department of Health Policy and Management (iBMG), PO Box 1738, 3000 DR Rotterdam, The Netherlands
3 Erasmus University, Institute for Medical Technology Assessment (iMTA), PO Box 1738, 3000 DR Rotterdam, The Netherlands
4 Erasmus Medical Centre, Department of Neurology, PO Box 2040, 3000 CA Rotterdam, The Netherlands
5 School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
6 Department of International Health, Johns Hopkins School of Public Health, Baltimore, USA
Cost Effectiveness and Resource Allocation 2010, 8:21 doi:10.1186/1478-7547-8-21
Published: 17 November 2010Abstract
Background
Economic 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.
Methods
The 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.
Results
Lifetime 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.
Conclusions
Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.