The burden of stroke in the Netherlands: estimating quality of life and costs for 1 year poststroke

Abstract

ObjectivesTo assess and explore over 1 year poststroke (1) the societal costs, (2) changes in costs and quality of life (QoL) and (3) the relation between costs and QoL.DesignThe current study is a burden of disease study focusing on the cost-of-illness (in Euros) and QoL (in utilities) after stroke.SettingAdult patients with stroke were recruited from stroke units in hospitals and followed for 1 year.ParticipantsData were collected from 395 patients with stroke.Main outcome measuresCosts and QoL expressed in utilities.MethodsCost categories were identified through a bottom-up method. The Dutch 3-level 5-dimensional EuroQol (EQ-5D-3L) was used to calculate utilities. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs and QoL. Robustness of results was tested via sensitivity analyses.ResultsThe total societal costs for 1 year poststroke were €29 484 (n=352) of which 74% were in the first 6 months. QoL remained stable over time. The discharge location was a significant predictor for cost and QoL; men had a significantly higher QoL than women and younger patients (<65) had significantly more costs than older patients (>65). Ceiling effects appear on all dimension of the EQ-5D-3L. Costs and QoL show a weak correlation (r=−0.29). Sensitivity analyses showed robustness of results.ConclusionsWe found lower patient costs and higher QoL than expected. This may be explained by the good state of health of our study population and by change in the Dutch healthcare system, which has led to considerable shorter hospitalisation poststroke. Future research must question the use of the EQ-5D-3L in a similar population due to ceiling effects.Trial registration numberNTR3051.

Early mobilization and quality of life after stroke

“…This is inevitable, given the inclusion of participants across the full stroke severity spectrum. The rate of missing data, however, was very low when compared to that of other poststroke QOL studies, 35 and is a tribute to the work ethic of the blinded assessors. Fewer than 5% of all participants were excluded from analysis of AQoL-4D at 12 months due to refusing follow-up, being lost to follow-up, or having missing data.…”

Die Kosten des Schlaganfalls in Deutschland: eine systematische Übersichtsarbeit

“…Die Schwankungen der Kosten in Abhängigkeit des Schweregrades und der Folgebeeinträchtigungen decken sich mit Ergebnissen internationaler Studien [40]. Weiterhin lässt sich in Übereinstimmung mit anderen Analysen festhalten, dass die initiale Phase mit der stationären Versorgung besonders kostenintensiv ist [41][42][43]. Demnach entstanden etwa drei Viertel der Kosten des ersten Jahres innerhalb der ersten 6 Monate nach dem Schlaganfall.…”

Early cost-utility analysis of tissue-engineered heart valves compared to bioprostheses in the aortic position in elderly patients

“…Since, the mean follow-up of the Bern TAVI Registry was only one year, it is likely that the occurrence rate of valve thrombosis after TAVI found in this study will not remain constant but will reduce over time. Therefore, we recalculated the linearized occurrence rate of 0.69%/patient-year, assuming that it will be zero from year 7 onwards 6 Dirichlet distribution parameters: α 1 = number of deaths, α 2 = number of re-interventions, α 3 = number of other treatment 7 Multivariate normal distribution: coefficients of the regression model are randomly drawn from a multivariate normal distribution based on coefficients and variance-covariance matrix 4 months after surgical re-intervention [23], 1 month after transcatheter re-intervention [23], and 28.2 days after stroke [24]. Informal care costs were assumed to be unchanged after in-hospital treatment of bleeding and prosthetic valverelated events, because care associated with these events is provided in-hospital.…”

“…After re-intervention, we assumed equal informal care costs as after the initial intervention. After stroke, we assumed that 54% of patients used informal care for 13.5 h/week during the first half year and 8.3 h/week during the second half year and subsequent years [24].…”