Stroke treatment economic model (STEM) - Predicting long-term costs from functional status

Background and Purpose - Stroke is a debilitating disease with long-term wi th long-term social and economic consequences. As new therapies for acute i schemic stroke are forthcoming, there is an increasing need to understand t heir long-term economic implications. To address this need, a stroke econom ic model was created. Methods - The model consists of 3 modules. A short-term module incorporates short-term clinical trial data. A long-term module composed of several Mar kov submodels predicts patient transitions among various locations over tim e. The modules are connected via a bridge component that groups the survivo rs at the end of the short-term module according to their functional status and location. Examples of analyses that can be conducted with this model a re provided with the use of data from 2 international trials. For illustrat ion, UK unit costs were estimated. Results-With the trial data in the short-term module, the short-term manage ment cost is estimated to be pound 8326 (US $13 649 [USD]). Hospital stay w as the major cost driver. By the end of the trials, there was pronounced di fference in the distribution of patient locations between functional groups . It is predicted in the long-term module that the subsequent cost amounts to pound 75 985 (124 564 USD) for a major and pound 27 995 (45 893 USD) for a minor stroke. Conclusions-Linking functional recovery at the end of short-term treatment with patients' treatment and residential locations allows this model to est imate the long-term economic impact of stroke interventions. Using patient location instead of the more common natural history as the model foundation allows quantification of the long-term impact to become data driven and he nce increases confidence in the results.