Dataset Information

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach.

ABSTRACT:

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.

SUBMITTER: Baeten SA

PROVIDER: S-EPMC2998455 | biostudies-literature | 2010 Nov

REPOSITORIES: biostudies-literature

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Publications

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach.

Baeten Stefan A SA van Exel N Job A NJ Dirks Maaike M Koopmanschap Marc A MA Dippel Diederik Wj DW Niessen Louis W LW

Cost effectiveness and resource allocation : C/E 20101117

<h4>Background</h4>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.<h4>Methods</h4>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 ...[more]

PMID: 21083901

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Project description:BackgroundIt is essential to have information on the disease burden of lung cancer at an individual level throughout the life; however, few such results have been reported. Thus, this study aimed to assess the lifetime disease burden in patients with lung cancer by assessing various factors, such as survival, years of life lost (YLL) and medical expenditure in South Korea based on real-world data and extrapolation.MethodsNewly diagnosed lung cancer patients (n?=?2919) in 2004-2010 were selected and observed until the end of 2015 using nationwide reimbursement claim database. The patients were categorised into the Surgery group, Chemo and/or Radiotherapy group (CTx/RTx), and Surgery+CTx/RTx according to their treatment modality. Age- and sex-matched control subjects were selected from among general population using the life table. The survival and cost data after diagnosis were analysed by a semi-parametric method, the Kaplan-Meier analysis for the first 100?months and rolling extrapolation algorithm for 101-300?months. YLL were derived from the difference in survival between patients and controls.ResultsLifetime estimates (standard error) were 4.5 (0.2) years for patients and 14.5 (0.1) years for controls and the derived YLL duration was 10.0 (0.2) years. Lifetime survival years showed the following trend: Surgery (14.2?years)?>?Surgery+CTx/RTx (8.5?years)?>?CTx/RTx group (3.0?years), and YLL were increased as lifetime survival years decreased (2.3, 8.7, 12.2?years, respectively). The mean lifetime medical cost was estimated at 30,857 USD/patient. Patients in the Surgery group paid higher treatment cost in first year after diagnosis, but the overall mean cost per year was lower at 4359 USD compared with 7075USD of Surgery+CTx/RTx or 7626USD of CTx/RTx group.ConclusionsLung cancer has resulted in about 10?years of life lost in overall patients. The losses were associated with treatment modality, and the results indicated that diagnosing lung cancer in patients with low stage disease eligible for surgery is beneficial for reducing disease burden in terms of survival and treatment cost per year throughout the life.

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Dataset Information

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach.

Background

Methods

Results

Conclusions

Publications

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach.

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