Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients

An observational cohort study in the Northern Territory of Australia

Yuejen Zhao, Steven Guthridge, Henrik Falhammar, Howard Flavell, Dominique A. Cadilhac

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    Abstract

    Objective: To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia.

    Design: Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents.

    Setting: Public hospitals in the NT from 1992 to 2013.

    Participants: Individual patient data were extracted and linked from the hospital inpatient and primary care information systems.

    Outcome measures: Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding.

    Results: 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25).

    Conclusions: Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.

    Original languageEnglish
    Article numbere015033
    Pages (from-to)1-10
    Number of pages10
    JournalBMJ Open
    Volume7
    Issue number10
    DOIs
    Publication statusPublished - 1 Oct 2017

    Fingerprint

    Northern Territory
    Cost-Benefit Analysis
    Observational Studies
    Cohort Studies
    Stroke
    Population
    Costs and Cost Analysis
    Delivery of Health Care
    losigame
    Survival
    Policy Making
    Public Hospitals
    Age of Onset
    Information Systems
    Health Care Costs
    Inpatients
    Primary Health Care
    Patient Care
    Outcome Assessment (Health Care)

    Cite this

    Zhao, Yuejen ; Guthridge, Steven ; Falhammar, Henrik ; Flavell, Howard ; Cadilhac, Dominique A. / Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients : An observational cohort study in the Northern Territory of Australia. In: BMJ Open. 2017 ; Vol. 7, No. 10. pp. 1-10.
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    title = "Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: An observational cohort study in the Northern Territory of Australia",
    abstract = "Objective: To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. Design: Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. Setting: Public hospitals in the NT from 1992 to 2013. Participants: Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. Outcome measures: Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. Results: 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0{\%}, disproportionately higher than the population proportion of 27{\%}). Of all cases, 42.6{\%} were ischaemic and 29.8{\%} haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4{\%} more hospital bed-days, and 7.4{\%} fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). Conclusions: Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.",
    keywords = "efficiency, health equity, social medicine, stroke",
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    Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients : An observational cohort study in the Northern Territory of Australia. / Zhao, Yuejen; Guthridge, Steven; Falhammar, Henrik; Flavell, Howard; Cadilhac, Dominique A.

    In: BMJ Open, Vol. 7, No. 10, e015033, 01.10.2017, p. 1-10.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients

    T2 - An observational cohort study in the Northern Territory of Australia

    AU - Zhao, Yuejen

    AU - Guthridge, Steven

    AU - Falhammar, Henrik

    AU - Flavell, Howard

    AU - Cadilhac, Dominique A.

    PY - 2017/10/1

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    N2 - Objective: To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. Design: Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. Setting: Public hospitals in the NT from 1992 to 2013. Participants: Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. Outcome measures: Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. Results: 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). Conclusions: Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.

    AB - Objective: To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. Design: Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. Setting: Public hospitals in the NT from 1992 to 2013. Participants: Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. Outcome measures: Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. Results: 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). Conclusions: Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.

    KW - efficiency

    KW - health equity

    KW - social medicine

    KW - stroke

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