title: Development and application of Model of Resource Utilization, Costs, and Outcomes for Stroke (MORUCOS): an Australian economic model for stroke.
abstract: OBJECTIVE
  To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]).
  
  
  METHODS
  The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions.
  
  
  RESULTS
  The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$ 15,117 versus AUD$ 17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997).
  
  
  CONCLUSIONS
  MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model.
authors.affiliation: The University of Melbourne, 4/207 Bouverie Street, Melbourne, 3010 Victoria, Australia. c.mihalopoulos@unimelb.edu.au
authors.forename: Catherine
authors.initials: C
authors.lastname: Mihalopoulos
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
authors.forename: Marjory L
authors.initials: ML
authors.lastname: Moodie
authors.forename: Helen M
authors.initials: HM
authors.lastname: Dewey
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Donnan
authors.forename: Robert C
authors.initials: RC
authors.lastname: Carter
mesh_terms: D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D018803:Models, Economic; D017063:Outcome Assessment, Health Care; D020521:Stroke / Q000628:therapy; D014739:Victoria