期刊
STROKE
卷 51, 期 4, 页码 1265-1271出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.119.027980
关键词
gross domestic product; quality-adjusted life-year; quality improvement; quality of care; uncertainty
资金
- National Natural Science Foundation of China [81971091, 81901177]
- Beijing Hospitals Authority Youth Programme [QML20190501]
- Ministry of Science and Technology of the People's Republic of China [2016YFC0901002, 2016YFC0901001, 2017YFC1310901, 2017YFC1310902, 2017Y FC1307905, 2018YFC1311700, 2018YFC1311706]
- Beijing Municipal Administration of Hospitals [SML20150502]
- Beijing Municipal Science & Technology Commission [D171100003017002, D151100002015003]
- National Science and Technology Major Project [2017ZX09304018]
- Beijing Tiantan Hospital [2018-YQN-1]
- Sanofi (CP-STROKE project)
Background and Purpose-Multifaceted quality improvement interventions of stroke care have been shown to improve hospital personnel adherence to evidence-based performance measures and subsequent stroke outcomes. This study aimed to evaluate the cost-effectiveness of a multifaceted quality improvement intervention for stroke care in China, the world's largest low- and middle-income country. Methods-A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of a multifaceted quality improvement intervention for patients with acute ischemic stroke. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and the published literature. The benefit of the intervention was assessed by the costs per quality-adjusted life-years gained in the short- and long-term. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the findings. Results-Compared with usual care, a multifaceted quality improvement intervention for stroke care was found to be cost-effective in the first year and highly cost-effective from the second year onward. In the long-term, the intervention yielded a lifetime gain of 0.246 quality-adjusted life-years at an additional cost of Chinese Yuan Renminbi 1510 (US $230), resulting in a cost of Chinese Yuan Renminbi 6138 (US $940) per quality-adjusted life-year gained. Probabilistic sensitivity analysis indicated that the intervention was highly cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of Chinese Yuan Renminbi 59 700 (1x gross domestic product per capita of China in 2017, US $9200) per quality-adjusted life-year. Conclusions-A multifaceted quality improvement intervention for stroke care was highly cost-effective in China. The results of this study may be used as a reference for delivering such interventions in low- and middle-income countries and in underserved areas of high-income countries.
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