Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Cost-effectiveness simulation modelling of chronic disease management plans among survivors of stroke   (#108)

Zhomart Orman 1 , Dominique Cadilhac 1 2 , Nadine Andrew 3 4 , Monique Kilkenny 1 2 , Muideen Olaiya 1 , Amanda Thrift 1 , David Ung 3 4 , Lachlan Dalli 1 , Vijaya Sundararajan 5 , Leonid Churilov 6 , Natasha Lannin 7 8 , Mark Nelson 9 , Velandai Srikanth 3 4 , Joosup Kim 1 2
  1. Department of Medicine, Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
  2. Stroke Division, Florey Institute of Neuroscience and Mental Health, Parkville, Vic, Australia
  3. Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Vic, Australia
  4. National Centre for Healthy Ageing, Frankston, Vic, Australia
  5. Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, Vic, Australia
  6. Melbourne Medical School, University of Melbourne, Melbourne, Vic, Australia
  7. Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Vic, Australia
  8. Alfred Health, Melbourne, Vic, Australia
  9. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tas, Australia

Background: There is limited evidence of the cost-effectiveness of chronic disease management plans (CDMPs) funded by the Australian government in the long-term after stroke.

Aims: To estimate the potential cost-effectiveness of CDMPs over a lifetime in people who survived the first 6 months after stroke/TIA.

Methods: A Markov model was developed to simulate costs and benefits of CDMPs over a time horizon of 30 years. Three health states were modelled (stable, hospitalised, dead) with one-year cycles. Model inputs were obtained from studies that included community-dwelling survivors of stroke/TIA. Transition probabilities and costs of resource utilisation from an Australian government funded health system perspective were obtained from the PRECISE study, a data linkage of the Australian Stroke Clinical Registry (cohort n=12,368) with government administrative datasets (hospital, Medicare claims, and pharmaceutical claims data). Quality-adjusted life years (QALYs), according to receipt of CDMP claims, were obtained from a cohort of survivors of stroke/TIA from a complementary randomised controlled trial (STANDFIRM, n=563 linked with Medicare claims and death data). A 3% discount rate was applied to costs in Australian dollars ($) and QALYs beyond 12 months. Probabilistic sensitivity analyses, with 10,000 iterations, were used to describe uncertainty around the incremental cost-effectiveness ratio (ICER).

Results: Compared to not having a CDMP claim, estimated average total lifetime costs ($124,752 vs. $89,080 per patient) and average total QALYs (7.241 vs. 6.835 per patient) were greater in the CDMP claim group, resulting in an ICER of $87,739 per QALY gained. Assuming a willingness-to-pay threshold of $50,000/QALY gained, there was a 42.41% probability of CDMPs being cost-effective.

Conclusion: It did not appear that the current use of CDMPs was cost-effective for survivors of stroke/TIA compared to care provided in general practices without a CDMP. Further research to optimise the use of CDMPs for this cohort is warranted.