title: The burden of stroke in the Netherlands: estimating quality of life and costs for 1 year poststroke.
abstract: OBJECTIVE
  To assess and explore over 1 year poststroke (1) the societal costs, (2) changes in costs and quality of life (QoL) and (3) the relation between costs and QoL.
  
  
  METHODS
  The current study is a burden of disease study focusing on the cost-of-illness (in Euros) and QoL (in utilities) after stroke.
  
  
  METHODS
  Adult patients with stroke were recruited from stroke units in hospitals and followed for 1 year.
  
  
  METHODS
  Data were collected from 395 patients with stroke.
  
  
  METHODS
  Costs and QoL expressed in utilities.
  
  
  METHODS
  Cost categories were identified through a bottom-up method. The Dutch 3-level 5-dimensional EuroQol (EQ-5D-3L) was used to calculate utilities. Non-parametric bootstrapping was applied to test for statistical differences in costs. Subgroup analyses were performed to identify predictors for costs and QoL. Robustness of results was tested via sensitivity analyses.
  
  
  RESULTS
  The total societal costs for 1 year poststroke were €29 484 (n=352) of which 74% were in the first 6 months. QoL remained stable over time. The discharge location was a significant predictor for cost and QoL; men had a significantly higher QoL than women and younger patients (<65) had significantly more costs than older patients (>65). Ceiling effects appear on all dimension of the EQ-5D-3L. Costs and QoL show a weak correlation (r=-0.29). Sensitivity analyses showed robustness of results.
  
  
  CONCLUSIONS
  We found lower patient costs and higher QoL than expected. This may be explained by the good state of health of our study population and by change in the Dutch healthcare system, which has led to considerable shorter hospitalisation poststroke. Future research must question the use of the EQ-5D-3L in a similar population due to ceiling effects.
  
  
  BACKGROUND
  NTR3051.
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Faculty of Health, Medicine & Life Sciences MHeNS, Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Eeden
authors.affiliation: Faculty of Health, Medicine & Life Sciences MHeNS, Department of Psychiatry & Neuropsychology, School for Mental Health & Neuroscience, Maastricht University, Maastricht, The Netherlands Faculty of Psychology & Neuroscience, Department of Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands.
authors.forename: C
authors.initials: C
authors.lastname: van Heugten
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
authors.forename: G A P G
authors.initials: GA
authors.lastname: van Mastrigt
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Mierlo
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
authors.forename: J M A
authors.initials: JM
authors.lastname: Visser-Meily
authors.affiliation: Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands Department of Public Mental Healthcare, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
authors.forename: S M A A
authors.initials: SM
authors.lastname: Evers
mesh_terms: D000368:Aged; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D057566:Self Report; D020521:Stroke / Q000191:economics*
keywords: HEALTH ECONOMICS