Economic evaluation of a patient and carer centred system of longer-term stroke care from a cluster randomised trial (the LoTS care trial)
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KeywordsUsual Care Stroke Patient Informal Care Societal Perspective General Health Questionnaire
Stroke generates considerable personal and financial burdens to society. We evaluated the cost-effectiveness of a new post-discharge system of care for stroke care co-ordinators (SCCs) to address the longer term problems experienced by stroke patients and their carers.
Materials and methods
A pragmatic cluster, randomised, controlled trial compared the system of care against usual care. Randomisation was at the level of stroke service. Participants’ use of health/social care services and informal care were measured by self-complete questionnaires at baseline, 6 and 12 months. From these, we estimated and compared individual-level total costs from health/social care and societal perspectives at 6 months, 12 months and over 1 year. Costs were combined with the primary outcome, psychological health (General Health Questionnaire 12; GHQ12), and quality-adjusted life years (QALYs; based on the EQ-5D) to examine cost-effectiveness at 6 months. Cost-effectiveness acceptability curves based on the net benefit approach and bootstrapping techniques were used to estimate the probability of cost-effectiveness.
32 services were randomised, of which 29 participated, and 800 stroke patients (401 intervention, 399 control) and 208 carers (108 intervention, 100 control) were recruited. Costs of SCC inputs (mean difference £42; 95% CI: -30, 116) and total health and social care costs at 6 months, 12 months and over 1 year were similar between groups. Total costs from the societal perspective were higher in the intervention group due to greater use of informal care (+£1163 at 6 months, 95% CI 56 to 3271; +£4135 at 12 months, 95% CI 618 to 7652). There were no differences in GHQ12 or QALYs and the probability of the system of care being cost-effective at 6 months was low at the current policy threshold of £20,000 to £30,000 per QALY gain.
The system of care was not cost-effective compared with usual care in this patient group over the period we examined. It is unclear why the intervention group accessed greater levels of informal care.
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