Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual

Daan P J Verberne; Ghislaine A P G van Mastrigt; Rudolf W H M Ponds; Caroline M van Heugten; Mariëlle E A L Kroese

doi:10.1136/bmjopen-2020-039201

Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual

Daan P J Verberne, Ghislaine A P G van Mastrigt^*, Rudolf W H M Ponds, Caroline M van Heugten, Mariëlle E A L Kroese

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual. Design Economic evaluation within a comparative effectiveness research design. Setting Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. Results Health outcomes were significantly better in stroke aftercare for QALYs (Delta=0.05; 95% CI 0.01 to 0.09) and social participation (Delta=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Healthcare costs were in total euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Average costs of stroke aftercare were euro91 (SD=euro3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of euro24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a euro50 000 willingness-to-pay level. Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.

Original language	English
Article number	e039201
Pages (from-to)	1-13
Number of pages	13
Journal	BMJ Open
Volume	11
Issue number	2
DOIs	https://doi.org/10.1136/bmjopen-2020-039201
Publication status	Published - 25 Feb 2021

Keywords

health economics
health services administration &amp
management
primary care
stroke
COST-EFFECTIVENESS ANALYSIS
FOCUSED FOLLOW-UP
BASE-LINE
TRANSIENT ISCHEMIC ATTACK
HOSPITAL-CARE
TRIAL
CARDIAC-ARREST
REHABILITATION
HEALTH
QUALITY-OF-LIFE

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@article{6417e9e4b28b45e7865b926774fc800e,

title = "Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual",

abstract = "Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual. Design Economic evaluation within a comparative effectiveness research design. Setting Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. Results Health outcomes were significantly better in stroke aftercare for QALYs (Delta=0.05; 95% CI 0.01 to 0.09) and social participation (Delta=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Healthcare costs were in total euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Average costs of stroke aftercare were euro91 (SD=euro3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of euro24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a euro50 000 willingness-to-pay level. Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.",

keywords = "health economics, health services administration &amp, management, primary care, stroke, COST-EFFECTIVENESS ANALYSIS, FOCUSED FOLLOW-UP, BASE-LINE, TRANSIENT ISCHEMIC ATTACK, HOSPITAL-CARE, TRIAL, CARDIAC-ARREST, REHABILITATION, HEALTH, QUALITY-OF-LIFE",

author = "Verberne, {Daan P J} and {van Mastrigt}, {Ghislaine A P G} and Ponds, {Rudolf W H M} and {van Heugten}, {Caroline M} and Kroese, {Mari{\"e}lle E A L}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2021",

month = feb,

day = "25",

doi = "10.1136/bmjopen-2020-039201",

language = "English",

volume = "11",

pages = "1--13",

journal = "BMJ Open",

issn = "2044-6055",

publisher = "BMJ Publishing Group",

number = "2",

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TY - JOUR

T1 - Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome

T2 - a comparison to care-as-usual

AU - Verberne, Daan P J

AU - van Mastrigt, Ghislaine A P G

AU - Ponds, Rudolf W H M

AU - van Heugten, Caroline M

AU - Kroese, Mariëlle E A L

N1 - © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2021/2/25

Y1 - 2021/2/25

N2 - Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual. Design Economic evaluation within a comparative effectiveness research design. Setting Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. Results Health outcomes were significantly better in stroke aftercare for QALYs (Delta=0.05; 95% CI 0.01 to 0.09) and social participation (Delta=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Healthcare costs were in total euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Average costs of stroke aftercare were euro91 (SD=euro3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of euro24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a euro50 000 willingness-to-pay level. Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.

AB - Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual. Design Economic evaluation within a comparative effectiveness research design. Setting Primary care (2016-2017) and community settings (2011-2013) in the Netherlands. Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation. Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke. Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale. Results Health outcomes were significantly better in stroke aftercare for QALYs (Delta=0.05; 95% CI 0.01 to 0.09) and social participation (Delta=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Healthcare costs were in total euro1208 higher in stroke aftercare than in care-as-usual (95% CI -euro3881 to euro6057). Average costs of stroke aftercare were euro91 (SD=euro3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of euro24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a euro50 000 willingness-to-pay level. Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.

KW - health economics

KW - health services administration &amp

KW - management

KW - primary care

KW - stroke

KW - COST-EFFECTIVENESS ANALYSIS

KW - FOCUSED FOLLOW-UP

KW - BASE-LINE

KW - TRANSIENT ISCHEMIC ATTACK

KW - HOSPITAL-CARE

KW - TRIAL

KW - CARDIAC-ARREST

KW - REHABILITATION

KW - HEALTH

KW - QUALITY-OF-LIFE

U2 - 10.1136/bmjopen-2020-039201

DO - 10.1136/bmjopen-2020-039201

M3 - Article

C2 - 33632749

SN - 2044-6055

VL - 11

SP - 1

EP - 13

JO - BMJ Open

JF - BMJ Open

IS - 2

M1 - e039201

ER -

Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual

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Keywords

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