Development of a decision-analytic model of stroke care in the United States and Europe
Development of a decision-analytic model of stroke care in the United States and Europe
复制标题
DOI：
10.1046/j.1524-4733.2002.52011.x
复制
发表时间：
2002-03-01
期刊：
影响因子：
4.5
通讯作者：
Hutton, J
中科院分区：
文献类型：
--
作者：
Chambers, MG;Koch, P;Hutton, J
目的：中风在过早死亡、残疾和护理费用方面给社会带来巨大负担。新的干预措施越来越需要在广泛实施之前证明其成本效益。临床试验无法衡量这些新干预措施对中风护理的长期影响，因此有必要采用建模方法。中风预后模型已在四个国家：法国，德国，英国和美国作为一个灵活的toot for this purpose.Method：决策分析模型代表急性中风的管理和长期护理和预防复发的中风幸存者。后者由半马尔可夫状态转移过程组成，健康状态由治疗、残疾和进一步卒中的发生定义。临床数据来源包括试验、荟萃分析和前瞻性队列研究，如牛津郡社区卒中项目和北方曼哈顿卒中研究。资源使用数据来自已发表的来源和专家临床医生小组。结果的措施，避免中风，生命年，质量调整生命年gained.Results：该模型已被用来进行经济分析的抗血小板治疗，预防复发性中风，中风病房护理和溶栓治疗急性中风。从卫生和社会保健的角度来看，新的干预措施被认为是节省费用或提供健康福利，在适度的额外费用。结果，对成本前景、英里范围、卒中复发的基线风险和有效性测量的选择敏感。该模型的发展强调了改善卒中幸存者预后和资源使用信息的必要性，以及区分经济上不同的终点（如死亡、残疾生存和非残疾生存）的重要性，这可能会在临床试验中结合起来作为结果。
Objective: Stroke places a huge burden on society in terms of premature death, disability, and costs of care. Increasingly, the cost-effectiveness of new interventions needs to be demonstrated before their widespread implementation. Clinical trials are unable to measure the long-term impact of such new interventions in stroke care, and a modeling approach is necessary. The Stroke Outcome Model has been developed in four Countries: France, Germany, the United Kingdom, and the United States as a flexible toot for this purpose.Method: The decision-analytic model represents the management of acute stroke and long-term care and prevention of recurrence for stroke survivors. The latter consists of semi-Markov state-transition processes, with health states defined by therapy, disability, and occurrence of Further stroke. Source S Of Clinical data include trials, meta-analyses, and prospective cohort studies such as the Oxfordshire Community Stroke Project and the Northern Manhattan Stroke Study. Resource use data were obtained from published sources and expert clinician panels. Outcome measures used were strokes averted, life years, and quality-adjusted life-years gained.Results: The model has been used to undertake economic analyses of antiplatelet therapy for the prevention of recurrent strokes, and of stroke unit care and thrombolytic therapy in acute stroke. From a health- and social-care perspective, new interventions were found to be cost saving or to provide health benefits at modest additional cost. Result, were sensitive to the cost perspective, mile horizon, baseline risk of stroke recurrence, and choice of effectiveness measure.Conclusion: The development of this model highlights the need for improved information on prognosis and resources used by stroke survivors and the importance of differentiating between economically distinct end points Such as death, disabled survival and nondisabled survival, which may tic combined as outcomes in clinical trials.