TY - JOUR
T1 - Economic evaluation of nurse-led stroke aftercare addressing long-Term psychosocial outcome: A comparison to care-As-usual
AU - Verberne, Daan P. J.
AU - van Mastrigt, Ghislaine A. P. G.
AU - Ponds, Rudolf W. H. M.
AU - van Heugten, Caroline M.
AU - Kroese, Mariëlle E. A. L.
N1 - Publisher Copyright: © Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2/25
Y1 - 2021/2/25
N2 - Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-As-usual. Design Economic evaluation within a comparative effectiveness research design. Setting Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-As-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-Adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. Results Health outcomes were significantly better in stroke aftercare for QALYs ("=0.05; 95% CI 0.01 to 0.09) and social participation ("=4.91; 95% CI 1.89 to 7.93) compared with care-As-usual. Total societal costs were €1208 higher in stroke aftercare than in care-As-usual (95% CI-€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-As-usual (95% CI-€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-To-pay level. Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-As-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.
AB - Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-As-usual. Design Economic evaluation within a comparative effectiveness research design. Setting Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-As-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-Adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. Results Health outcomes were significantly better in stroke aftercare for QALYs ("=0.05; 95% CI 0.01 to 0.09) and social participation ("=4.91; 95% CI 1.89 to 7.93) compared with care-As-usual. Total societal costs were €1208 higher in stroke aftercare than in care-As-usual (95% CI-€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-As-usual (95% CI-€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-To-pay level. Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-As-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.
KW - health economics
KW - health services administration & management
KW - primary care
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85101718339&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/bmjopen-2020-039201
DO - https://doi.org/10.1136/bmjopen-2020-039201
M3 - Article
C2 - 33632749
SN - 2044-6055
VL - 11
JO - BMJ Open
JF - BMJ Open
IS - 2
M1 - e039201
ER -