22. European Stroke Conference 584 © 2013 S. Karger AG, Basel Scientific Programme 23 Rehabilitation and reorganisation after stroke Cluster randomised trial evaluation of a patient and carer centred system of longer-term stroke care (the LoTS care trial): economic evaluation A. Patel1, A. Forster2, J. Young3, J. Nixon4, K. Chapman5, M. Knapp6, K. Mellish7, I. Holloway8, A. Farrin9 King’s College London, London, UNITED KINGDOM1, University of Leeds, Leeds, UNIT-ED KINGDOM2, University of Leeds, Leeds, UNITED KINGDOM3, University of Leeds, Leeds, UNITED KINGDOM4, University of Leeds, Leeds, UNITED KINGDOM5, King’s College London & London School of Economics & Political Science, London, UNITED KINGDOM6, University of Leeds, Leeds, UNITED KINGDOM7, University of Leeds, Leeds, UNITED KINGDOM8, Universi-ty of Leeds, Leeds, UNITED KINGDOM9 Background Stroke generates considerable personal and financial burdens. We evaluated the cost-effectiveness of a new post-discharge system of care for stroke care co-ordinators (SCCs) to address longer term problems experienced by stroke patients and their carers. Methods A pragmatic cluster, randomised, controlled trial compared the system of care against usual care, with randomisation 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 out-come, 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 es-timate the probability of cost-effectiveness. Results 32 services were randomised and 800 stroke patients (401 intervention, 399 control) and 208 car-ers (108 intervention, 100 control) were recruited. Costs of SCC inputs (mean difference £42; 95% CI: -30, 116) and total health/social care costs at 6 months, 12 months and over 1 year were similar between groups. Societal costs 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. 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. Conclusions The system of care was not cost-effective compared with usual care over the period we examined. The intervention group may have accessed more informal care due to the goal setting element of the intervention. 22 Rehabilitation and reorganisation after stroke Withdrawn!
Karger_ESC London_2013
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