A systematic review of cost-effectiveness research of stroke evaluation and treatment

Background and Purpose-This work was undertaken to review research addressi ng the cost-effectiveness of stroke-related diagnostic, preventive, or ther apeutic interventions. Methods-We performed searches of MEDLINE, Excerpta Medica online, HealthSTA R, and Sciences Citation Index Expanded and examined the reference lists of the studies and reviews obtained. From these, we selected studies that rep orted an incremental analysis of cost per effect, in which the effect measu re was life-years or quality-adjusted life-years. We abstracted data from e ach study using a standardized reporting form. Twenty-six articles met the eligibility criteria and were included in the review. Results-The methodological quality of the articles reviewed has improved co mpared with previously reported. Many stroke evaluation and treatment polic ies may result in benefits to health that are considered worth their cost. Some interventions were considered cost-ineffective (anticoagulation in low -risk nonvalvular atrial fibrillation and surveillance with duplex ultrasou nd after endarterectomy). Different studies addressing the cast-effectivene ss of screening asymptomatic carotid stenosis resulted in strikingly diverg ent conclusions, from being cost-effective to being detrimental. Other stud ies omitted important costs that, if included, would likely have had profou nd impact on their cost-effectiveness estimates. Conclusions-Given the divergent conclusions drawn from studies addressing s imilar questions, it may be premature to use the results of cost-effectiven ess research in developing stroke policy and practice guidelines. Successfu l implementation of such evaluations in the care of patients with stroke wi ll depend on further standardization of methodology and critical appraisal of reported findings.