[Calculation of costs of stroke, cost effectiveness of stroke units and secondary prevention in patients after a stroke, as recommended by revised CBO practice guideline 'Stroke'].
OBJECTIVE
Economic analyses have been part of the revision of the Dutch multi-disciplinary stroke guidelines. We evaluated the recommendations on stroke units and prevention of stroke recurrencies in terms of medical costs and health effects among stroke patients.


METHODS
Cost calculation.


METHODS
Mathematical modelling of medical costs per patient and costs per life year gained without severe stroke (Rankin score (> 3)), by age and sex for each guideline.


RESULTS
Lifetime costs of stroke depended on age and sex and vary between 84,000 and 292,000 Dutch guilders (HFL). The cost-effectiveness of stroke units decreases with age and varies between HFL 37,000 and HFL 60,200 with a large uncertainty range. Four of seven options in secondary prevention were cost-effective by previously established criteria (< HFL 40,000 per year gained without severe disease). Acetylsalicylic acid remained the drug of choice for monotherapy with dipyridamol as a second choice in patients without atrial fibrillation. Clopidogrel was not cost-effective at the current cost level. Anticoagulation after stroke in case of atrial fibrillation was cost-effective.


CONCLUSIONS
Given a short hospital stay stroke units can be as affective as other hospital interventions. Acetylsalicylic acid is the most cost effective monotherapy for secondary prevention.
Niessen
L W
LW
Instituut voor Medical Technology Assessment, Erasmus Universitair Medisch Centrum/Erasmus Universiteit, Rotterdam. niessen@bmg.eur.nl
Dippel
D W
DW
Limburg
M
M
D000367:Age Factors; D001241:Aspirin / Q000191:economics; D000077144:Clopidogrel; D003362:Cost-Benefit Analysis; D004176:Dipyridamole / Q000191:economics; D016527:Drug Costs; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000191:economics*; D007902:Length of Stay / Q000191:economics*; D018803:Models, Economic; D009426:Netherlands; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention; D012737:Sex Factors; D020521:Stroke / Q000191:economics* / Q000517:prevention & control / Q000628:therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics
D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin