Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands.
MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands.
Int J Environ Res Public Health. 2022 Sep 5;19(17):11110. doi: 10.3390/ijerph191711110.
(1) Background: This study aimed to investigate two-year societal costs and generic health-related quality of life (QoL) using a bottom-up approach for the Restore4Stroke Cohort. (2) Methods: Adult post-stroke patients were recruited from stroke units throughout the Netherlands. The societal costs were calculated for healthcare and non-healthcare costs in the first two years after stroke. The QoL was measured using EQ-5D-3L. The differences between (sub)groups over time were investigated using a non-parametric bootstrapping method. (3) Results: A total of 344 post-stroke patients were included. The total two-year societal costs of a post-stroke were EUR 47,502 (standard deviation (SD = EUR 2628)). The healthcare costs decreased by two thirds in the second year -EUR 14,277 (95% confidence interval -EUR 17,319, -EUR 11,236). In the second year, over 50% of the total societal costs were connected to non-healthcare costs (such as informal care, paid help, and the inability to perform unpaid labor). Sensitivity analyses confirmed the importance of including non-healthcare costs for long-term follow-up. The subgroup analyses showed that patients who did not return home after discharge, and those with moderate to severe stroke symptoms, incurred significantly more costs compared to patients who went directly home and those who reported fewer symptoms. QoL was stable over time except for the stroke patients over 75 years of age, where a significant and clinically meaningful decrease in QoL over time was observed. (4) Conclusions: The non-healthcare costs have a substantial impact on the first- and second-year total societal costs post-stroke. Therefore, to obtain a complete picture of all the relevant costs related to a stroke, a societal perspective with a follow-up of at least two years is highly recommended. Additionally, more research is needed to investigate the decline in QoL found in stroke patients above the age of 75 years.
(1) 背景：本研究旨在通过恢复 4 卒中队列的自下而上方法，调查两年的社会成本和通用健康相关生活质量（QoL）。(2) 方法：从荷兰各地的卒中病房招募成年卒中后患者。在卒中后两年内，计算医疗保健和非医疗保健成本的社会成本。使用 EQ-5D-3L 测量 QoL。使用非参数引导方法研究随时间的（亚）组差异。(3) 结果：共纳入 344 例卒中后患者。卒中后两年的总社会成本为 47502 欧元（标准差（SD=2628 欧元））。第二年医疗保健成本减少了三分之二-14277 欧元（95%置信区间（欧元 17319，欧元 11236））。第二年，超过 50%的总社会成本与非医疗保健成本（如非正式护理、有偿帮助和无法从事无报酬劳动）有关。敏感性分析证实了在长期随访中纳入非医疗保健成本的重要性。亚组分析表明，与直接回家的患者和报告症状较少的患者相比，出院后未回家的患者和有中度至重度卒中症状的患者的成本显著增加。除了 75 岁以上的卒中患者外，QoL 在随时间稳定，在随时间观察到 QoL 显著且具有临床意义的下降。(4) 结论：非医疗保健成本对卒中后第一和第二年的总社会成本有重大影响。因此，为了全面了解与卒中相关的所有相关成本，建议从社会角度进行至少两年的随访。此外，需要更多的研究来调查 75 岁以上卒中患者发现的 QoL 下降。
