Moodie Marjory L, Carter Robert, Mihalopoulos Cathrine, Thrift Amanda G, Chambers Brian R, Donnan Geoffrey A, Dewey Helen M
National Stroke Research Institute, Health, Heidelberg Heights, Australia.
Stroke. 2004 May;35(5):1041-6. doi: 10.1161/01.STR.0000125012.36134.89. Epub 2004 Mar 18.
Cost-effectiveness data for stroke interventions are limited, and comparisons between studies are confounded by methodological inconsistencies. The aim of this study was to trial the use of the intervention module of the economic model, a Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS) to facilitate evaluation and ranking of the options.
The approach involves using an economic model together with added secondary considerations. A consistent approach was taken using standard economic evaluation methods. Data from the North East Melbourne Stroke Incidence Study (NEMESIS) were used to model "current practice" (base case), against which 2 interventions were compared. A 2-stage process was used to measure benefit: health gains (expressed in disability-adjusted life years [DALYs]) and filter analysis. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic uncertainty analysis was undertaken.
Aspirin, a low-cost intervention applicable to a large number of stroke patients (9153 first-ever cases), resulted in modest health benefits (946 DALYs saved) and a mean ICER (based on incidence costs) of US 1421 dollars per DALY saved. Although the health gains from recombinant tissue-type plasminogen activator (rtPA) were less (155 DALYs saved), these results were impressive given the small number of persons (256) eligible for treatment. rtPA dominates current practice because it is more effective and cost-saving.
If used to assess interventions across the stroke care continuum, MORUCOS offers enormous capacity to support decision-making in the prioritising of stroke services.
中风干预措施的成本效益数据有限，且研究之间的比较因方法学上的不一致而混淆。本研究的目的是试用经济模型的干预模块，即中风资源利用、成本和结果模型（MORUCOS），以促进对各种选择的评估和排序。
该方法涉及使用经济模型并附加次要考虑因素。采用标准经济评估方法采取一致的方法。来自墨尔本东北部中风发病率研究（NEMESIS）的数据用于模拟“当前实践”（基础案例），并与两种干预措施进行比较。采用两阶段过程来衡量效益：健康收益（以伤残调整生命年[DALYs]表示）和筛选分析。计算增量成本效益比（ICERs），并进行概率不确定性分析。
阿司匹林是一种低成本干预措施，适用于大量中风患者（9153例首发病例），带来适度的健康效益（节省946个DALYs），每节省一个DALY的平均ICER（基于发病成本）为1421美元。尽管重组组织型纤溶酶原激活剂（rtPA）带来的健康收益较少（节省155个DALYs），但鉴于 eligible for treatment的人数较少（256人），这些结果令人印象深刻。rtPA优于当前实践方法，因为它更有效且节省成本。
如果用于评估整个中风护理连续过程中的干预措施，MORUCOS在支持中风服务优先级决策方面具有巨大能力。
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