Health-related quality of life measures for a cost-effectiveness analysis of ischemic stroke therapies

Stroke treatment and prevention has witnessed a dramatic development in recent years, especially in developed countries. The objective of this study was to calculate the costs and cost effectiveness of the treatment of ischemic stroke in a Czech stroke center using semi-objective neurological measures - the modified Rankin Score (mRS), the National Institute of Health Stroke Scale (NIHSS), and the Modified Thrombolysis In Cerebral Infarction Scale (mTICI). Three possible interventions were investigated: intravenous thrombolysis, neurointerventional radiology, and both interventions applied in succession. In terms of both short-term and long-term effects, from the hospital as well as the health insurance company perspective, the most cost-effective intervention proved to be intravenous thrombolysis - for patients with both less and more severe stroke. This corresponds to the results of our literature search. The study supports the suitability of the chosen HRQoL measures for analyses of clinical effectiveness and cost-effectiveness of stroke therapies. In stroke patients, mRS, NIHSS, mTICI are more stable and have a better predictive value than QALYs based on patient-reported values.