Die Kosten des Schlaganfalls in Deutschland: eine systematische Übersichtsarbeit

Düvel, Juliane; Damm, Oliver; Greiner, Wolfgang

doi:10.1055/a-1258-5683

Cited by 4 publications

(4 citation statements)

References 38 publications

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“…The risks of dying or long-term disability increase significantly with each subsequent stroke [ 10 ]. In addition to the individual burden of stroke, such as permanent impairment in everyday life, and the national economic impact of premature deaths, chronic consequences and disabilities are associated with high financial and personnel challenges for healthcare systems [ 11 , 12 , 13 ]. Cardiovascular diseases, and predominantly coronary heart disease and stroke, cause the largest direct costs compared to all other diseases [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Duevel,

Gruhn,

Grosser

et al. 2024

Healthcare

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Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0–4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384–1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data.

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Section: Introductionmentioning

confidence: 99%

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Duevel,

Gruhn,

Grosser

et al. 2024

Healthcare

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“… 37 , 38 Therefore, the base case analysis was extended by assuming average rehabilitation and care costs after a stroke or acute coronary syndrome (myocardial infarctions) from the literature. 39–41 In order to examine the impact of varying cost estimates in the literature, scenario analyses with minimum and maximum reported costs were conducted. In addition, an extreme scenario assuming that every stroke would lead to inpatient care needs and long-term care at the highest level was analysed.…”

Section: Methodsmentioning

confidence: 99%

Cost-effectiveness of early rhythm control vs. usual care in atrial fibrillation care: an analysis based on data from the EAST-AFNET 4 trial

et al. 2023

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Aims The randomized, controlled EAST-AFNET 4 trial showed that early rhythm control (ERC) reduces the rate of a composite primary outcome (cardiovascular death, stroke, or hospitalization for worsening heart failure or acute coronary syndrome) by ∼20%. The current study examined the cost-effectiveness of ERC compared to usual care. Methods and results This within-trial cost-effectiveness analysis was based on data from the German subsample of the EAST-AFNET 4 trial (n = 1664/2789 patients). Over a 6-year time horizon and from a healthcare payer’s perspective, ERC was compared to usual care regarding costs (hospitalization and medication) and effects (time to primary outcome; years survived). Incremental cost-effectiveness ratios (ICERs) were calculated. Cost-effectiveness acceptability curves were constructed to visualize uncertainty. Early rhythm control was associated with higher costs [+€1924, 95% CI (−€399, €4246)], resulting in ICERs of €10 638 per additional year without a primary outcome and €22 536 per life year gained. The probability of ERC being cost-effective compared to usual care was ≥95% or ≥80% at a willingness-to-pay value of ≥€55 000 per additional year without a primary outcome or life year gained, respectively. Conclusion From a German healthcare payer’s perspective, health benefits of ERC may come at reasonable costs as indicated by the ICER point estimates. Taking statistical uncertainty into account, cost-effectiveness of ERC is highly probable at a willingness-to-pay value of ≥€55 000 per additional life year or year without a primary outcome. Future studies examining the cost-effectiveness of ERC in other countries, subgroups with higher benefit from rhythm control therapy, or cost-effectiveness of different modes of ERC are warranted.

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“…Among the patients who survive the initial stroke, a quarter of patients die within the first year, and more than one-third of survivors suffer from permanent restrictions and depend on supportive care 4. In addition to the individual burdens and the economic impact of premature deaths, chronic consequences and disabilities are associated with high personnel and financial challenges for the healthcare system, causing one of the largest direct cost blocks compared with all other diseases 5. In 2017, total healthcare costs of stroke amounted to over 9.1 billion Euros in Germany and accounted for 2.60% of total healthcare expenditure 6…”

Section: Introductionmentioning

confidence: 99%

Health economic evaluation of the ‘Flying Intervention Team’ as a novel stroke care concept for rural areas: study protocol of the TEMPiS-GÖA study

et al. 2022

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IntroductionProviding comprehensive stroke care poses major organisational and financial challenges to the German healthcare system. The quasi-randomised TEMPiS–Flying Intervention Team (TEMPiS-FIT) study aims to close the gap in the treatment of patients who had ischaemic stroke in rural areas of Southeast Bavaria by flying a team of interventionalists via helicopter directly to patients in the regional TEMPiS hospitals instead of transporting the patients to the next comprehensive stroke centre. The objective of the present paper is to describe the methods for the economic evaluation (TEMPiS-Gesundheitsökonomische Analyse (TEMPiS-GÖA)) alongside the TEMPiS-FIT study to determine whether the new form of care is cost-effective compared with standard care.Methods and analysisThe within-trial cost-effectiveness analysis (CEA) and cost–utility analysis (CUA) will be performed from a statutory health insurance perspective as well as from a societal perspective over the time horizon of 12 months after the patients’ hospital discharge. Direct costs from outpatient and inpatient care are collected from routine data of the participating health insurance funds, while medical and non-medical costs from a patient’s perspective are retrieved from primary data collected during the TEMPiS-FIT study and follow-up questionnaires. Results will be presented as incremental cost-effectiveness ratio and incremental cost-utility ratio quantifying the incremental costs and health benefits compared with standard care practice. The outcome of the CEA will be measured in costs per minute reduction in mean process time to thrombectomy. The outcome of the CUA will be presented as costs per quality-adjusted life year gained.Ethics and disseminationEthical approval for the TEMPiS-FIT study was granted by the Bavarian State Medical Association Ethics Committee (# 17056). Results will be disseminated via reports, presentations of the results in publications and at conferences and on the TEMPiS website.Trial registration numberGerman Clinical Trials Register DRKS00023885. Registered on 2 July 2021 – retrospectively registered.

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Die Kosten des Schlaganfalls in Deutschland: eine systematische Übersichtsarbeit

Cited by 4 publications

References 38 publications

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Secondary Prevention via Case Managers in Stroke Patients: A Cost-Effectiveness Analysis of Claims Data from German Statutory Health Insurance Providers

Cost-effectiveness of early rhythm control vs. usual care in atrial fibrillation care: an analysis based on data from the EAST-AFNET 4 trial

Health economic evaluation of the ‘Flying Intervention Team’ as a novel stroke care concept for rural areas: study protocol of the TEMPiS-GÖA study

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