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(Stroke. 2004;35:203.)
© 2004 American Heart Association, Inc.

Original Contributions

Editorial Comment—Stroke Cost-Effectiveness Research: Are Acceptability Curves Acceptable?

Departments of Neurology and Community & Preventive Medicine, University of Rochester Medical Center, Rochester, New York

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Stroke, Patel et al examine the cost-effectiveness of 3 different care strategies for patients with moderately disabling stoke: stroke unit care, stroke team care, and domiciliary care.¹ The results show that stroke unit care was more effective and more costly than the other 2 competing strategies, and based on the incremental comparison of stroke unit care compared with domiciliary care (stroke team care was dominated because it was less effective and more costly than stroke unit care), stroke unit care costs an additional £64 000 to £136 000 per quality-adjusted life year (QALY) gained. The authors rightly point out several limitations that need to be kept in mind, the most important of which is limited generalizability given the known differences in stroke care patterns across countries. Another important limitation not mentioned is that different methods of eliciting health state preferences yield different estimates of QALYs for equivalent health states, and such differences need to be kept in mind, considering the authors used only the EuroQol (EQ-5D) as a preference measure and imputed the baseline values.² This article, however, is important for several reasons.

First, it demonstrates that cost and cost-effectiveness information can be collected, analyzed, and interpreted in the context of stroke treatment trials. To date, the majority of cost-effectiveness analyses for stroke-related interventions have been performed using decision-analytic modeling or have been methodologically limited economic evaluations piggy-backed onto cohort studies or clinical trials.^3,4 Obtaining cost and effect data from the same population, as in . . . [Full Text of this Article]