Resource costs, health outcomes and cost-effectiveness in stroke care: Evidence from the Oxford Vascular Study

Cerebrovascular disorders, such as strokes, have high mortality, disability and healthcare costs. However, there is a lack of information on their costs and outcomes, information that is vital in order for the NHS to make accurate decisions. In my doctorate the costs and outcomes of stroke and transient ischaemic attacks (TIA), which are similar to very minor strokes, were estimated using data from a large study undertaken in Oxfordshire. My work also estimated the factors affecting patients‘ quality of life, disability, and costs to the NHS. Results showed that the prevention of further strokes decreased NHS costs and improved patients‘ quality of life. However, with a high risk of suffering another stroke shortly after TIA or minor stroke, prevention of further events needs to be timely in order to be effective. This is not the case, however, as patients tend to wait more than 14 days to be assessed and treated. The final part of my work evaluated the costs and outcomes of faster clinical assessment and treatment for such patients. This award would allow me to disseminate the results of my doctorate thesis.

Cerebrovascular disorders are a major source of mortality, neurological disability and health care resource use. Despite this, there is a lack of reliable information on their costs and outcomes, particularly in transient ischaemic attacks (TIA) and minor stroke. Such information is vital not only to inform decision about service provision both locally and nationally, but also to provide reliable estimates for use in cost-effectiveness analysis of prevention and treatment strategy. In my DPhil thesis the costs, quality of life and disability after a cerebrovascular event were estimated using data from a population-based incidence study undertaken in a population of over 91,000 individuals in Oxfordshire. With multiple and overlapping methods of case ascertainment, the Oxford Vascular Study (OXVASC) is the first-ever study of its kind. In order to inform the planning of service provision, especially for those patients considered as being at high risk of recurrent stroke, analyses undertaken as part of my DPhil also estimated the size and predictors of immediate and longer-term health care costs and outcomes of cerebrovascular disorders. With stroke having serious consequences in terms of mortality and disability, its prevention will have a huge impact on NHS resources. Data from OXVASC have shown that there is a very high risk of recurrent stroke during the first few days after a TIA or minor stroke. Therefore, the potential benefit of secondary stroke prevention relies on a short window of opportunity. However, with relatively low hospitalisation rates for TIA and minor stroke, this would entail faster access to outpatient specialist care, as approximately half of all these patients currently wait more than 14 days to be assessed and treated. As a result, using data from an observational study undertaken as part of OXVASC, the final part of my thesis evaluated the cost-effectiveness of faster clinical assessment and treatment after TIA or minor stroke. Using the work undertaken as part of my DPhil thesis the main aim of this project would be to disseminate its results, together with the methodology used to derive them. Furthermore, this project would allow a more in depth analysis in areas of the thesis were either due to word-limit or time constraints some of the outcome data collected was not examined.