Wellcome Trust Clinical Research Career Development Fellow, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, Oxford, UK.
Neurosciences Department, Santa Maria Hospital/CHULN, University of Lisbon, Lisbon, Portugal.
Eur J Neurol. 2021 Feb;28(2):717-725. doi: 10.1111/ene.14583. Epub 2020 Nov 18.
Stroke is the second leading cause of death and dependency in Europe and costs the European Union more than €30bn, yet significant gaps in the patient pathway remain and the cost-effectiveness of comprehensive stroke care to meet these needs is unknown. The European Brain Council Value of Treatment Initiative combined patient representatives, stroke experts, neurological societies and literature review to identify unmet needs in the patient pathway according to Rotterdam methodology. The cost-effectiveness of comprehensive stroke services was determined by a Markov model, using UK cost data as an exemplar and efficacy data for prevention of death and dependency from published systematic reviews and trials, expressing effectiveness as quality-adjusted life-years (QALYs). Model outcomes included total costs, total QALYs, incremental costs, incremental QALYs and the incremental cost-effectiveness ratio (ICER). Key unmet needs in the stroke patient pathway included inadequate treatment of atrial fibrillation (AF), access to neurorehabilitation and implementation of comprehensive stroke services. In the Markov model, full implementation of comprehensive stroke services was associated with a 9.8% absolute reduction in risk of death of dependency, at an intervention cost of £9566 versus £6640 for standard care, and long-term care costs of £35 169 per 5.1251 QALYS vs. £32 347.40 per 4.5853 QALYs, resulting in an ICER of £5227.89. Results were robust in one-way and probabilistic sensitivity analyses. Implementation of comprehensive stroke services is a cost-effective approach to meet unmet needs in the stroke patient pathway, to improve acute stroke care and support better treatment of AF and access to neurorehabilitation.
中风是欧洲第二大致死和致残原因，给欧盟造成的损失超过 300 亿欧元，但患者治疗路径仍存在重大差距，且全面脑卒中护理以满足这些需求的成本效益尚不清楚。欧洲脑委会治疗价值倡议联合患者代表、中风专家、神经病学学会和文献回顾，根据鹿特丹方法确定患者治疗路径中的未满足需求。全面脑卒中服务的成本效益通过马尔可夫模型确定，使用英国成本数据作为范例，以及预防死亡和依赖的功效数据来自已发表的系统评价和试验，用质量调整生命年（QALYs）表示效果。模型结果包括总成本、总 QALYs、增量成本、增量 QALYs 和增量成本效益比（ICER）。中风患者治疗路径中的关键未满足需求包括心房颤动（AF）治疗不足、获得神经康复和实施全面脑卒中服务。在马尔可夫模型中，全面实施脑卒中服务与死亡和依赖风险降低 9.8%相关，干预成本为 9566 英镑，而标准护理为 6640 英镑，长期护理成本为每 5.1251 QALY 35169 英镑，而每 4.5853 QALY 32347.40 英镑，ICER 为 5227.89 英镑。单因素和概率敏感性分析结果稳健。全面实施脑卒中服务是满足中风患者治疗路径中未满足需求的一种具有成本效益的方法，可改善急性中风护理，并支持更好地治疗 AF 和获得神经康复。
