title: Cost-effectiveness analysis of stroke management under a universal health insurance system.
abstract: 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.
authors.affiliation: Department of Neurology, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Ku-Chou
authors.initials: KC
authors.lastname: Chang
authors.forename: Hsuei-Chen
authors.initials: HC
authors.lastname: Lee
authors.forename: Yu-Ching
authors.initials: YC
authors.lastname: Huang
authors.forename: Jen-Wen
authors.initials: JW
authors.lastname: Hung
authors.forename: Hsienhsueh Elley
authors.initials: HE
authors.lastname: Chiu
authors.forename: Jin-Jong
authors.initials: JJ
authors.lastname: Chen
authors.forename: Tsong-Hai
authors.initials: TH
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D017721:Hospital Costs / Q000592:standards* / Q000706:statistics & numerical data; D006748:Hospital Departments / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D018803:Models, Economic; D009493:Neurosurgery; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D010362:Patients' Rooms / Q000191:economics; D012047:Rehabilitation Centers / Q000191:economics; D012189:Retrospective Studies; D012494:Sampling Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000145:classification / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D000071939:Stroke Rehabilitation; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D019472:Universal Health Insurance / Q000191:economics*