Erasmus University, Department of Health Policy and Management (iBMG), PO Box 1738, 3000 DR Rotterdam, The Netherlands.
Cost Eff Resour Alloc. 2010 Nov 17;8:21. doi: 10.1186/1478-7547-8-21.
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.
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.
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.
Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.
对脑卒中服务的经济评估表明，此类服务可能以可负担的成本提高生活质量。本研究在综合服务环境中评估脑卒中的终身健康影响和成本后果。
EDISSE 研究是一项前瞻性非随机对照集群试验，比较了脑卒中服务（n = 151 例患者）和常规护理（n = 187 例患者）。健康状况和成本试验数据输入多维脑卒中生命表中。这些表格区分了由改良 Rankin 量表定义的四个残疾水平。基于同时进行的荷兰随访研究，质量调整生命年（QALY）和生存概率。按残疾程度区分了终生医疗费用和生活质量调整后的生命年。通过对每个治疗组的患者进行成本和效果数据的自举，经济分析比较了成功的脑卒中服务与常规护理的结果。
脑卒中后的终生成本和 QALY 取决于首次脑卒中的发病年龄。在常规护理中，男性患者的脑卒中后终生 QALY 为 2.42（90%CI -0.49 至 2.75），女性为 2.75（-0.61 至 6.26）。在常规护理环境中，男性患者的终生成本为 39335 欧元（15951 欧元；79837 欧元），女性为 42944 欧元（14081 欧元；95944 欧元）。与脑卒中服务进行比较，获得每单位 QALY 的增量成本效益比（ICER）为 11685 欧元（男性和女性分别为 14211 欧元和 7745 欧元）。这种脑卒中服务在 90%的置信度下具有成本效益。
从终身角度来看，我们的分析表明，脑卒中服务具有提高健康效益和节省成本的潜力，即使在其他欧洲环境中也是如此。
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