2013-06-19T21:11:48Z http://repub.eur.nl/oai

oai:repub.eur.nl/res/pub/24001 2013-01-18T09:42:50Z org:9802 org:9825 org:9755 org:9729 org:9746 access:open type:article

urn:NBN:nl:ui:15-1765/24001 2013-01-18T09:42:50 mods http://hdl.handle.net/1765/24001 hdl:1765/24001 urn:NBN:nl:ui:15-1765/24001 doi:10.1186/1478-7547-8-21 Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach text article http://hdl.handle.net/1765/24001 http://repub.eur.nl/res/pub/24001/21083901_OA.pdf application/pdf Filesize: 431 KB born digital Background: 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.Methods: 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.Results: 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.Conclusions: Our analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings. Baeten, S.A. Baeten Stefan aut Exel, N.J.A. van Exel, van Job aut Dirks, M. Dirks Maaike aut Koopmanschap, M.A. Koopmanschap Marc aut Dippel, D.W.J. Dippel Diederik aut Niessen, L.W. Niessen Louis Wilhelmus aut 218167636 071906789 114000867 111171741 Instituut Beleid en Management Gezondheidszorg - Health policy and management (iBMG) Supporting host sht en English Cost Effectiveness and Resource Allocation 1478-7547 8 1 10 2010-11-17 Erasmus University Rotterdam oai:repub.eur.nl/res/pub/24001 IR OAIPMH feed (http://repub.eur.nl/oai) 2011-08-02T08:38:49Z 2011-11-23T09:59:13Z http://purl.org/eprint/accessRights/OpenAccess