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Title: Value of Treatment by Comprehensive Stroke Services for the reduction of critical gaps in acute stroke care in Europe.
Austin Authors: Webb, Ajs;Fonseca, A C;Berge, E;Randall, G;Fazekas, F;Norrving, B;Nivelle, E;Thijs, Vincent N ;Vanhooren, G
Affiliation: Wellcome Trust Clinical Research Career Development Fellow, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford
Neurosciences Department, Santa Maria Hospital, CHULN, University of Lisbon, Lisbon, Portugal
Department of Internal Medicine, Oslo University Hospital, Oslo, Norway
European Research Manager at the Stroke Association (UK), Research Officer for the SAFE network, Portugal
Department of Neurology Medical, University of Graz, Landeskrankenhaus, Graz, Austria
Department of Clinical Sciences Lund, Neurology, Skåne University Hospital, Lund University, Lund, Sweden
Health Economics Consulting, Melbourne, Australia
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Australia
Department of Neurology, AZ Sint-Jan Brugge-Oostende, Brugge, Belgium
Issue Date: 12-Oct-2020
Date: 2020-10-12
Publication information: European Journal of Neurology 2020; online first: 12 October
Abstract: Stroke is the second leading cause of death and dependency in Europe and costs the EU >€30 billion, 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. 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, 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 £9,566 versus £6,640 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 £5,227.89. 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 atrial fibrillation and access to neurorehabilitation.
DOI: 10.1111/ene.14583
ORCID: 0000-0002-0630-8204
Journal: European Journal of Neurology
PubMed URL: 33043544
Type: Journal Article
Subjects: Acute Stroke care
Care pathway
Economic analysis
Value of treatment
Appears in Collections:Journal articles

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