Cost-effectiveness analysis of stroke management under a universal health insurance system

被引:16
作者
Chang, Ku-Chou [2 ,3 ,4 ,5 ]
Lee, Hsuei-Chen [1 ,6 ]
Huang, Yu-Ching [3 ,5 ]
Hung, Jen-Wen [7 ,10 ]
Chiu, Hsienhsueh Elley [2 ,8 ]
Chen, Jin-Jong [1 ,6 ]
Lee, Tsong-Hai [2 ,9 ]
机构
[1] Natl Yang Ming Univ, Dept Phys Therapy & Assist Technol, Taipei 11221, Taiwan
[2] Chang Gung Univ, Coll Med, Dept Neurol, Tao Yuan, Taiwan
[3] Kaohsiung Chang Gung Mem Hosp, Dept Neurol, Div Cerebrovasc Dis, Kaohsiung, Taiwan
[4] Kaohsiung Chang Gung Mem Hosp, Discharge Planning Serv Ctr, Kaohsiung, Taiwan
[5] Yuh Ing Jr Coll, Dept Senior Citizen Serv Management, Kaohsiung, Taiwan
[6] Natl Yang Ming Univ, Exercise & Hlth Sci Res Ctr, Taipei 11221, Taiwan
[7] Kaohsiung Chang Gung Mem Hosp, Dept Rehabil Med, Kaohsiung, Taiwan
[8] Kaohsiung Chang Gung Mem Hosp, Dept Tradit Chinese Med, Div Acupuncture & Traumatol, Kaohsiung, Taiwan
[9] Linkou Chang Gung Mem Hosp, Dept Neurol, Stroke Sess, Tao Yuan, Taiwan
[10] Chang Gung Univ, Coll Med, Dept Rehabil, Tao Yuan, Taiwan
关键词
Stroke/mortality/therapy; Cost of illness; Health resources/utilization; Retrospective studies; Survival analysis; ACUTE ISCHEMIC-STROKE; INTRACEREBRAL HEMORRHAGE; FOLLOW-UP; CASE-FATALITY; UNIT CARE; READMISSION; POPULATION; MORTALITY; REHOSPITALIZATION; HOSPITALIZATION;
D O I
10.1016/j.jns.2012.09.018
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objective: Cost-effectiveness analysis (CEA) of stroke management was evaluated in three care models: Neurology/Rehabilitation wards (NW), Neurosurgery wards (NS), and General/miscellaneous wards (GW) under a universal health insurance system. Methods: From 1997 to 2002, subjects with first-ever acute stroke were sampled from claims data of a nationally representative cohort in Taiwan, categorized as hemorrhage stroke (HS) including subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH); or, ischemic stroke (IS), including cerebral infarction (CI), transient ischemic attack/ unspecified stroke (TIA/unspecified); with mild-moderate and severe severity. All-cause readmissions or mortality (AE) and direct medical cost during first-year (FYMC) after stroke were explored. CEA was performed by incremental cost-effectiveness ratios. Results: 2368 first-ever stroke subjects including SAH 3.3%, ICH 17.9%, CI 49.8%, and TIA/unspecified 29.0% were identified with AE 59.0%, 63.0%, 48.6%, 46.8%, respectively. There were 50.8%, 13.5%, 35.6% of stroke patients served by NW, NS and GW with AE 44.9%, 60.6%, 56.0%. and medical costs of US$ 5,031, US$ 8,235, US$ 4,350, respectively. NW was cost-effective for both mild-moderate and severe IS. NS was the dominant care model in mild-moderate HS, while NW appeared to be a cost-minimization model for severe HS. Conclusions: TIA/unspecified stroke carried substantial risk of AE. NS performed better in serving mild-moderate HS, whereas NW was the optimal care model in management of IS. (C) 2012 Elsevier B.V. All rights reserved.
引用
收藏
页码:205 / 215
页数:11
相关论文
共 48 条
[1]  
[Anonymous], 2001, COCHRANE DB SYST REV, DOI [DOI 10.1002/14651858.CD000197, 10.1002/14651858.Cd000197]
[2]   Cost of acute ischemic and hemorrhagic stroke in Turkey [J].
Asi, Talip ;
Celik, Yahya ;
Sut, Necdet ;
Celik, Aygul Dogan ;
Balci, Kemal ;
Yilmaz, Arif ;
Karaduman, Fatih .
CLINICAL NEUROLOGY AND NEUROSURGERY, 2011, 113 (02) :111-114
[3]   Readmission and death after hospitalization for acute ischemic stroke - 5-Year follow-up in the medicare population [J].
Bravata, Dawn M. ;
Ho, Shih-Yieh ;
Meehan, Thomas P. ;
Brass, Lawrence M. ;
Concato, John .
STROKE, 2007, 38 (06) :1899-1904
[4]  
Bureau of National Health Insurance Department of Health Executive Yuan in Taiwan. National Health Insurance in Taiwan, 2012, NAT HLTH INS TAIW 20
[5]   The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS) [J].
Cadilhac, Dominique A. ;
Dewey, Helen M. ;
Vos, Theo ;
Carter, Rob ;
Thrift, Amanda G. .
HEALTH AND QUALITY OF LIFE OUTCOMES, 2010, 8
[6]   Stroke-unit care for acute stroke patients: an observational follow-up study [J].
Candelise, Livia ;
Gattinoni, Monica ;
Bersano, Anna ;
Micieli, Giuseppe ;
Sterzi, Roberto ;
Morabito, Alberto .
LANCET, 2007, 369 (9558) :299-305
[7]   Prehospital delay after acute stroke in Kaohsiung, Taiwan [J].
Chang, KC ;
Tseng, MC ;
Tan, TY .
STROKE, 2004, 35 (03) :700-704
[8]   A NEW METHOD OF CLASSIFYING PROGNOSTIC CO-MORBIDITY IN LONGITUDINAL-STUDIES - DEVELOPMENT AND VALIDATION [J].
CHARLSON, ME ;
POMPEI, P ;
ALES, KL ;
MACKENZIE, CR .
JOURNAL OF CHRONIC DISEASES, 1987, 40 (05) :373-383
[9]   Validation of the National Health Insurance Research Database with ischemic stroke cases in Taiwan [J].
Cheng, Ching-Lan ;
Kao, Yea-Huei Yang ;
Lin, Swu-Jane ;
Lee, Cheng-Han ;
Lai, Ming Liang .
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2011, 20 (03) :236-242
[10]   Ischemic stroke and intracerebral hemorrhage: The latest evidence on mortality, readmissions and hospital costs from Scotland [J].
Christensen, Michael C. ;
Munro, Vicki .
NEUROEPIDEMIOLOGY, 2008, 30 (04) :239-246