The health loss from ischemic stroke and intracerebral hemorrhage: evidence from the North East Melbourne Stroke Incidence Study (NEMESIS)

Health and Quality of Life Outcomes

Research

Rob Carter¹  Amanda G Thrift²  Dominique A Cadilhac³  Helen M Dewey⁴  Theo Vos⁵ 

[1] Deakin Health Economics, Deakin University, 3125, Burwood, Australia;National Stroke Research Institute, Heidelberg Heights, 3081, Vic, Australia;Baker IDI Heart and Diabetes Institute, Melbourne, Australia;Department Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia;National Stroke Research Institute, Heidelberg Heights, 3081, Vic, Australia;Department of Medicine, The University of Melbourne, 3010, Australia;Deakin Health Economics, Deakin University, 3125, Burwood, Australia;National Stroke Research Institute, Heidelberg Heights, 3081, Vic, Australia;Department of Medicine, The University of Melbourne, 3010, Australia;Department of Neurology, Austin Health, 3084, Heidelberg, Australia;School of Population Health, University of Queensland, 4006, Herston, Australia;

关键词: Ischemic Stroke;    Stroke Survivor;    Stroke Subtype;    Utility Loss;    Health Loss;   

DOI  :  10.1186/1477-7525-8-49

 received in 2009-09-04, accepted in 2010-05-14,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPeople suffering different types of stroke have differing demographic characteristics and survival. However, current estimates of disease burden are based on the same underlying assumptions irrespective of stroke type. We hypothesized that average Quality Adjusted Life Years (QALYs) lost from stroke would be different for ischemic stroke and intracerebral hemorrhage (ICH).MethodsWe used 1 and 5-year data collected from patients with first-ever stroke participating in the North East Melbourne Stroke Incidence Study (NEMESIS). We calculated case fatality rates, health-adjusted life expectancy, and quality-of-life (QoL) weights specific to each age and gender category. Lifetime 'health loss' for first-ever ischemic stroke and ICH surviving 28-days for the 2004 Australian population cohort was then estimated. Multivariable uncertainty analyses and sensitivity analyses (SA) were used to assess the impact of varying input parameters e.g. case fatality and QoL weights.ResultsPaired QoL data at 1 and 5 years were available for 237 NEMESIS participants. Extrapolating NEMESIS rates, 31,539 first-ever strokes were expected for Australia in 2004. Average discounted (3%) QALYs lost per first-ever stroke were estimated to be 5.09 (SD 0.20; SA 5.49) for ischemic stroke (n = 27,660) and 6.17 (SD 0.26; SA 6.45) for ICH (n = 4,291; p < 0.001). QALYs lost also differed according to gender for both subtypes (ischemic stroke: males 4.69 SD 0.38, females 5.51 SD 0.46; ICH: males 5.82 SD 0.67, females 6.50 SD 0.40).DiscussionPeople with ICH incurred greater loss of health over a lifetime than people with ischemic stroke. This is explained by greater stroke related case fatality at a younger age, but longer life expectancy with disability after the first 12 months for people with ICH. Thus, studies of disease burden in stroke should account for these differences between subtype and gender. Otherwise, in countries where ICH is more common, health loss for stroke may be underestimated. Similar to other studies of this type, the generalisability of the results may be limited. Sensitivity and uncertainty analyses were used to provide a plausible range of variation for Australia. In countries with demographic and life expectancy characteristics comparable to Australia, our QoL weights may be reasonably applicable.

【 授权许可】

CC BY   
© Cadilhac et al; licensee BioMed Central Ltd. 2010