Department of Epidemiology, New York University College of Global Public Health, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA.
Department of Epidemiology, New York University College of Global Public Health, New York, NY, USA.
Value Health. 2019 Nov;22(11):1240-1247. doi: 10.1016/j.jval.2019.06.003. Epub 2019 Jul 27.
Less than 25% of stroke patients arrive to an emergency department within the 3-hour treatment window.
We evaluated the cost-effectiveness of a stroke preparedness behavioral intervention study (Stroke Warning Information and Faster Treatment [SWIFT]), a stroke intervention demonstrating capacity to decrease race-ethnic disparities in ED arrival times.
Using the literature and SWIFT outcomes for 2 interventions, enhanced educational (EE) materials, and interactive intervention (II), we assess the cost-effectiveness of SWIFT in 2 ways: (1) Markov model, and (2) cost-to-outcome ratio. The Markov model primary outcome was the cost per quality-adjusted life-year (QALY) gained using the cost-effectiveness threshold of $100 000/QALY. The primary cost-to-outcome endpoint was cost per additional patient with ED arrival <3 hours, stroke knowledge, and preparedness capacity. We assessed the ICER of II and EE versus standard care (SC) from a health sector and societal perspective using 2015 USD, a time horizon of 5 years, and a discount rate of 3%.
The cost-effectiveness of the II and EE programs was, respectively, $227.35 and $74.63 per additional arrival <3 hours, $440.72 and $334.09 per additional person with stroke knowledge proficiency, and $655.70 and $811.77 per additional person with preparedness capacity. Using a societal perspective, the ICER for EE versus SC was $84 643 per QALY gained and the ICER for II versus EE was $59 058 per QALY gained. Incorporating fixed costs, EE and II would need to administered to 507 and 1693 or more patients, respectively, to achieve an ICER of $100 000/QALY.
II was a cost-effective strategy compared with both EE and SC. Nevertheless, high initial fixed costs associated with II may limit its cost-effectiveness in settings with smaller patient populations.
不到 25%的中风患者能在 3 小时治疗窗口期内到达急诊科。
我们评估了一项中风预备行为干预研究（中风预警信息和更快治疗 [SWIFT]）的成本效益，该研究表明能够减少急诊室到达时间的种族和民族差异。
使用文献和 SWIFT 的两项干预措施（增强教育[EE]材料和互动干预[II]）的结果，我们以两种方式评估 SWIFT 的成本效益：（1）马尔可夫模型，和（2）成本效益比。马尔可夫模型的主要结果是每获得一个质量调整生命年（QALY）的成本，使用 10 万美元/QALY 的成本效益阈值。主要的成本效益终点是每增加一个在 3 小时内到达急诊室的患者、中风知识和准备能力的成本。我们从卫生部门和社会角度评估了 II 和 EE 相对于标准护理（SC）的增量成本效益比（ICER），使用 2015 年美元，时间范围为 5 年，贴现率为 3%。
II 和 EE 计划的成本效益分别为每增加 3 小时内到达的患者<3 小时、每增加一名具有中风知识熟练程度的患者<3 小时、每增加一名具有准备能力的患者<3 小时的成本分别为 227.35 美元和 74.63 美元、440.72 美元和 334.09 美元、655.70 美元和 811.77 美元。从社会角度看，EE 相对于 SC 的 ICER 为每获得一个 QALY 增加 84643 美元，II 相对于 EE 的 ICER 为每获得一个 QALY 增加 59058 美元。如果考虑固定成本，EE 和 II 分别需要对 507 名和 1693 名或更多的患者进行治疗，才能达到 10 万美元/QALY 的 ICER。
与 EE 和 SC 相比，II 是一种具有成本效益的策略。然而，II 与较高的初始固定成本相关，这可能限制其在患者人数较少的环境中的成本效益。
