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Trial application of a model of resource utiliztion, costs, and outcomes for stroke (MORUCOS) to assist priority setting in stroke.
journal contribution
posted on 2004-03-18, 00:00 authored by Marj MoodieMarj Moodie, Rob CarterRob Carter, Cathy MihalopoulosCathy Mihalopoulos, A Thrift, B Chambers, G Donnan, H DeweyBackground and Purpose— Cost-effectiveness data for stroke interventions are limited, and comparisons between studies are confounded by methodological inconsistencies. The aim of this study was to trial the use of the intervention module of the economic model, a Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS) to facilitate evaluation and ranking of the options.
Methods— The approach involves using an economic model together with added secondary considerations. A consistent approach was taken using standard economic evaluation methods. Data from the North East Melbourne Stroke Incidence Study (NEMESIS) were used to model "current practice" (base case), against which 2 interventions were compared. A 2-stage process was used to measure benefit: health gains (expressed in disability-adjusted life years [DALYs]) and filter analysis. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic uncertainty analysis was undertaken.
Results— Aspirin, a low-cost intervention applicable to a large number of stroke patients (9153 first-ever cases), resulted in modest health benefits (946 DALYs saved) and a mean ICER (based on incidence costs) of US $1421 per DALY saved. Although the health gains from recombinant tissue-type plasminogen activator (rtPA) were less (155 DALYs saved), these results were impressive given the small number of persons (256) eligible for treatment. rtPA dominates current practice because it is more effective and cost-saving.
Conclusions— If used to assess interventions across the stroke care continuum, MORUCOS offers enormous capacity to support decision-making in the prioritising of stroke services.
Methods— The approach involves using an economic model together with added secondary considerations. A consistent approach was taken using standard economic evaluation methods. Data from the North East Melbourne Stroke Incidence Study (NEMESIS) were used to model "current practice" (base case), against which 2 interventions were compared. A 2-stage process was used to measure benefit: health gains (expressed in disability-adjusted life years [DALYs]) and filter analysis. Incremental cost-effectiveness ratios (ICERs) were calculated, and probabilistic uncertainty analysis was undertaken.
Results— Aspirin, a low-cost intervention applicable to a large number of stroke patients (9153 first-ever cases), resulted in modest health benefits (946 DALYs saved) and a mean ICER (based on incidence costs) of US $1421 per DALY saved. Although the health gains from recombinant tissue-type plasminogen activator (rtPA) were less (155 DALYs saved), these results were impressive given the small number of persons (256) eligible for treatment. rtPA dominates current practice because it is more effective and cost-saving.
Conclusions— If used to assess interventions across the stroke care continuum, MORUCOS offers enormous capacity to support decision-making in the prioritising of stroke services.
History
Journal
StrokeVolume
35Pagination
1041 - 1046Publisher
Lippincott Williams & WilkinsLocation
Philadelphia, PAPublisher DOI
ISSN
0039-2499eISSN
1524-4628Language
engNotes
published online Mar 18, 2004Publication classification
C1.1 Refereed article in a scholarly journalCopyright notice
2004, American Heart Association, Inc.Usage metrics
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No categories selectedKeywords
cerebrovascular disorderscost-benefit analysisaspirinthrombolytic therapyScience & TechnologyLife Sciences & BiomedicineClinical NeurologyPeripheral Vascular DiseaseNeurosciences & NeurologyCardiovascular System & CardiologyACUTE ISCHEMIC-STROKETISSUE-PLASMINOGEN ACTIVATORTHROMBOLYSISPERSPECTIVE(NEMESIS)\/AUSTRALIANEMESISCARE
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