Systematic Review of Cost-Effectiveness Research of Stroke Evaluation and Treatment
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To the Editor:
Holloway and colleagues’ review of cost-effectiveness studies in stroke evaluation and treatment1 may have inadvertently introduced major biases by the selection criteria used for inclusion of studies. They decided to include only studies that used quality-adjusted life-years (QALYs) as the indicator of health effect. The justification for this criterion is not given. By doing this, cost-effectiveness studies that used indicators such as lives saved or strokes avoided are excluded, and the authors do not provide information on study exclusions to allow the reader to assess the potential bias created.
The review is biased in two ways. First, the use of QALYs is inappropriate in many areas of stroke evaluation and management where measures of diagnostic accuracy, patient satisfaction, or reduction in symptoms are of relevance. It is noteworthy that the review excluded consideration of the most effective intervention for stroke management—organized stroke care and rehabilitation—for which reviews of cost-effectiveness studies have been performed.2 3 Thus, the review is biased in describing the range of cost-effectiveness studies in stroke.
Second, the …