Abstract for: Estimating costs and benefits of stroke management: A population-based simulation model of improvement scenarios
In the context of population aging and a growing body supporting effectiveness and economic evaluations of strategies for acute stroke care, this paper presents a population-level system dynamics (SD) model for Singapore to assess various stroke interventions for policy decision-making. The SD model investigates 12 intervention scenarios based on six stroke interventions (a public information campaign, improvements in thrombolysis, endovascular therapy, acute stroke unit, out-of-hospital rehabilitation, and secondary prevention), singly or in plausible combinations. Primary outcomes included the cumulative discounted costs and cumulative quality-adjusted life years (QALYs) gained between status quo and each intervention scenario by 2030, as well as cumulative net monetary benefits (NMB). Secondary outcomes included differences in stroke incidence, prevalence, and fatality rates, and cumulative care volumes between the status quo and each intervention scenario by 2030.All intervention scenarios, singly and combined, result in an increase in NMB compared to current practice of stroke management in Singapore by 2030. Furthermore, acute-care interventions, when combined with a public information campaign to raise awareness of stroke symptoms, leads to a synergistic increase in QALYs and NMB gained. As a single intervention strategy, an increase in out-of-hospital rehabilitation yielded the greatest value (in terms of NMB) cumulatively, by 2030.