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Value of treatment by comprehensive stroke services for the reduction of critical gaps in acute stroke care in Europe
European Journal of Neurology ( IF 5.1 ) Pub Date : 2020-10-12 , DOI: 10.1111/ene.14583 A J S Webb 1 , A C Fonseca 2 , E Berge 3 , G Randall 4 , F Fazekas 5 , B Norrving 6 , E Nivelle 7 , V Thijs 8 , G Vanhooren 9 ,
European Journal of Neurology ( IF 5.1 ) Pub Date : 2020-10-12 , DOI: 10.1111/ene.14583 A J S Webb 1 , A C Fonseca 2 , E Berge 3 , G Randall 4 , F Fazekas 5 , B Norrving 6 , E Nivelle 7 , V Thijs 8 , G Vanhooren 9 ,
Affiliation
Stroke is the second leading cause of death and dependency in Europe and costs the European Union more than €30bn, 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. The 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 (AF), 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 £9566 versus £6640 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 £5227.89. 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 AF and access to neurorehabilitation.
中文翻译:
综合卒中服务对缩小欧洲急性卒中护理严重差距的治疗价值
中风是欧洲第二大死亡和依赖原因,欧盟花费超过 300 亿欧元,但在患者途径中仍然存在重大差距,满足这些需求的综合中风护理的成本效益尚不清楚。欧洲脑委员会治疗价值倡议结合了患者代表、中风专家、神经学学会和文献回顾,以根据鹿特丹方法确定患者途径中未满足的需求。综合卒中服务的成本效益由马尔可夫模型确定,使用英国成本数据作为样本,并使用已发表的系统评价和试验中预防死亡和依赖的功效数据,将有效性表示为质量调整生命年 (QALYs) . 模型结果包括总成本、总 QALY、增量成本、增量 QALYs 和增量成本效益比 (ICER)。中风患者途径中未满足的主要需求包括心房颤动 (AF) 治疗不足、获得神经康复和实施全面的中风服务。在马尔可夫模型中,全面实施中风服务与依赖死亡风险的绝对降低 9.8% 相关,干预成本为 9566 英镑,而标准护理为 6640 英镑,长期护理成本为 35169 英镑每 5.1251 QALYS 与每 4.5853 QALYs 32 347.40 英镑,ICER 为 5227.89 英镑。结果在单向和概率敏感性分析中是稳健的。实施全面的中风服务是满足中风患者途径中未满足的需求的一种具有成本效益的方法,
更新日期:2020-10-12
中文翻译:
综合卒中服务对缩小欧洲急性卒中护理严重差距的治疗价值
中风是欧洲第二大死亡和依赖原因,欧盟花费超过 300 亿欧元,但在患者途径中仍然存在重大差距,满足这些需求的综合中风护理的成本效益尚不清楚。欧洲脑委员会治疗价值倡议结合了患者代表、中风专家、神经学学会和文献回顾,以根据鹿特丹方法确定患者途径中未满足的需求。综合卒中服务的成本效益由马尔可夫模型确定,使用英国成本数据作为样本,并使用已发表的系统评价和试验中预防死亡和依赖的功效数据,将有效性表示为质量调整生命年 (QALYs) . 模型结果包括总成本、总 QALY、增量成本、增量 QALYs 和增量成本效益比 (ICER)。中风患者途径中未满足的主要需求包括心房颤动 (AF) 治疗不足、获得神经康复和实施全面的中风服务。在马尔可夫模型中,全面实施中风服务与依赖死亡风险的绝对降低 9.8% 相关,干预成本为 9566 英镑,而标准护理为 6640 英镑,长期护理成本为 35169 英镑每 5.1251 QALYS 与每 4.5853 QALYs 32 347.40 英镑,ICER 为 5227.89 英镑。结果在单向和概率敏感性分析中是稳健的。实施全面的中风服务是满足中风患者途径中未满足的需求的一种具有成本效益的方法,