Trial application of a Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS) to assist priority setting in stroke.
OBJECTIVE
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 dollars 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.
Moodie
Marjory L
ML
National Stroke Research Institute, Health, Heidelberg Heights, Australia. mmoodie@unimelb.edu.au
Carter
Robert
R
Mihalopoulos
Cathrine
C
Thrift
Amanda G
AG
Chambers
Brian R
BR
Donnan
Geoffrey A
GA
Dewey
Helen M
HM
D000208:Acute Disease; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006292:Health Priorities; D006801:Humans; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D011994:Recombinant Proteins / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy* / Q000191:economics*; D015912:Thrombolytic Therapy / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000191:economics / Q000627:therapeutic use; D014600:Utilization Review
D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; D010959:Tissue Plasminogen Activator; D001241:Aspirin