Croatian Society for Pharmacoeconomics and Health Economics, Zagreb, Croatia.
Zem Solutions Ltd., Belgrade, Serbia.
Eur Stroke J. 2023 Jan;8(1 Suppl):21-27. doi: 10.1177/23969873221123840. Epub 2023 Feb 10.
The aim of this analysis was to estimate 1 year and long-term cost and quality of life of ischaemic stroke patients in Croatia. In addition, we aimed to identify and estimate key categories of costs and outcomes driving the burden of stroke in Croatian healthcare system.
Data were derived from analysis of the RES-Q Registry for Croatia in 2018 and supplemented with clinical expert opinion and relevant medical, clinical and economic literature to estimate the course of the disease and treatment patterns in Croatian healthcare system. The health economic model was comprised of a one-year discrete event simulation (DES) mapping real life patient experience and a 10-year Markov model built on existing literature. Cost and health resources use were obtained using Croatian tariffs. Health utilities were mapped to EQ5D from the Barthel Index utilising previously published studies.
The key aspects determining costs and quality of life were rehabilitation, discharge to residential care (currently 13% of patients in Croatia) and recurrent stroke. Total 1 year cost per patient was 18,221 EUR having 0.372 QALYs.
Direct costing structure of ischaemic stroke in Croatia is above the value of upper-middle income countries. Our study showed that post stroke rehabilitation seems to be a strong modifier of future post-stroke costs and further research into various models of post-stroke care and rehabilitation could be the answer into more successful rehabilitation that could increase QALY and reduce the economic burden of stroke. Further investment in rehabilitation research and provision might bring promising opportunities to improve long term patient outcomes.
本分析旨在评估克罗地亚缺血性脑卒中患者的 1 年和长期成本及生活质量。此外，我们旨在确定和评估导致克罗地亚医疗保健系统中脑卒中负担的关键成本和结果类别。
数据来自 2018 年 RES-Q 克罗地亚登记处的分析，并结合临床专家意见和相关医疗、临床和经济文献，以估计疾病的进程和克罗地亚医疗保健系统中的治疗模式。该健康经济模型由一年的离散事件模拟（DES）组成，该模拟反映了现实生活中患者的体验，以及基于现有文献建立的十年马尔可夫模型。使用克罗地亚关税获得成本和健康资源的使用情况。健康效用值通过先前发表的研究，从巴氏指数映射到 EQ5D。
决定成本和生活质量的关键因素是康复、转至养老院（目前克罗地亚有 13%的患者）和再次发生脑卒中。每位患者的 1 年总成本为 18221 欧元，具有 0.372 个质量调整生命年。
克罗地亚缺血性脑卒中的直接成本结构高于中上收入国家的水平。我们的研究表明，脑卒中后的康复似乎是未来脑卒中后成本的重要修正因素，进一步研究各种脑卒中后护理和康复模式可能是提高康复成功率的答案，这可以提高质量调整生命年并降低脑卒中的经济负担。进一步投资于康复研究和提供可能会带来改善长期患者预后的有前景的机会。
