Estimating costs and benefits of stroke management: A population-based simulation model

Abstract

The paper demonstrates how a system dynamics approach can support strategic planning of health care services and can in particular help to balance cost-effectiveness considerations with budget impact considerations when assessing a comprehensive package of stroke care interventions in Singapore. A population-level system dynamics model is used to investigate 12 intervention scenarios based on six stroke interventions (a public information campaign, thrombolysis, endovascular therapy, acute stroke unit (ASU), out-of-hospital rehabilitation, and secondary prevention). Primary outcomes included cumulative discounted costs and quality-adjusted life years (QALYs) gained, as well as cumulative net monetary benefit by 2030. All intervention scenarios result in an increase in net monetary benefit by 2030; much of these gains were realized through improved post-acute care. Findings highlight the importance of coordination of care, and affirms the economic value of current stroke interventions.

Keywords:

• System dynamics
• stroke
• health systems

Acknowledgements

Preliminary work for this project was carried out by Ms. Yuan Tian whose contribution we appreciate. We thank Martin Kunc and Sally Brailsford for providing helpful comments on the draft of this article.

Disclosure statement

Dr. Koh owns equity in a private tele-rehabilitation company, T-Rehab Private Limited. The other authors report no conflicts.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Singapore Ministry of Health’s National Medical Research Council under its STaR Award Grant (NMRC|STaR|0005|2009) as part of the project “Establishing a Practical and Theoretical Foundation for Comprehensive and Integrated Community, Policy and Academic Efforts to Improve Dementia Care in Singapore.”