Article Text

Original research
Economic evaluation of nurse-led stroke aftercare addressing long-term psychosocial outcome: a comparison to care-as-usual
  1. Daan P J Verberne1,2,
  2. Ghislaine A P G van Mastrigt3,
  3. Rudolf W H M Ponds1,2,4,5,
  4. Caroline M van Heugten1,2,6,
  5. Mariëlle E A L Kroese3
  1. 1Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Faculty of Health, Medicine and Neuroscience, School for Mental Health and Neuroscience (MHeNs), Maastricht, The Netherlands
  2. 2Limburg Brain Injury Centre, Maastricht, The Netherlands
  3. 3Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
  4. 4Department of Brain Injury Rehabilitation, Adelante Rehabilitation Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
  5. 5Department of Medical Psychology, Maastricht University Medical Centre, Maastricht, The Netherlands
  6. 6Department of Neuropsychology and Psychopharmacology, Maastricht University, Faculty of Psychology and Neuroscience, Maastricht, The Netherlands
  1. Correspondence to Dr Ghislaine A P G van Mastrigt; g.vanmastrigt{at}


Objective To examine the cost-effectiveness of nurse-led stroke aftercare addressing psychosocial outcome at 6 months post stroke, compared with care-as-usual.

Design Economic evaluation within a comparative effectiveness research design.

Setting Primary care (2016–2017) and community settings (2011–2013) in the Netherlands.

Participants Persons who suffered from ischaemic or haemorrhagic stroke, or a transient ischaemic attack and were discharged home after visiting the emergency department, hospitalisation or inpatient rehabilitation.

Interventions Nurse-led stroke aftercare at 6 months post stroke addressing psychosocial functioning by providing screening, psycho-education, emotional support and referral to specialist care when needed. Care-as-usual concerned routine follow-up care including secondary prevention programmes and a consultation with the neurologist at 6 weeks post stroke.

Primary and secondary outcome measures Main outcome measure of cost-effectiveness was quality-adjusted life years (QALYs) estimated by the quality of life measured by the five-dimensional, three-level EuroQol. Costs were assessed using a cost-questionnaire. Secondary outcomes were mood (Hospital Anxiety and Depression Scale) and social participation (Utrecht Scale for Evaluation of Rehabilitation-Participation) restrictions subscale.

Results Health outcomes were significantly better in stroke aftercare for QALYs (Δ=0.05; 95% CI 0.01 to 0.09) and social participation (Δ=4.91; 95% CI 1.89 to 7.93) compared with care-as-usual. Total societal costs were €1208 higher in stroke aftercare than in care-as-usual (95% CI −€3881 to €6057). Healthcare costs were in total €1208 higher in stroke aftercare than in care-as-usual (95% CI −€3881 to €6057). Average costs of stroke aftercare were €91 (SD=€3.20) per person. Base case cost-effectiveness analyses showed an incremental cost-effectiveness ratio of €24 679 per QALY gained. Probability of stroke aftercare being cost-effective was 64% on a €50 000 willingness-to-pay level.

Conclusions Nurse-led stroke aftercare addressing psychosocial functioning showed to be a low-cost intervention and is likely to be a cost-effective addition to care-as-usual. It plays an important role by screening and addressing psychosocial problem, not covered by usual care.

  • stroke
  • health economics
  • health services administration & management
  • primary care

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  • Contributors DPJV, RWHMP, CMvH and MEALK designed the study. DPJV acquired the data. DPJV, GAPGvM and MEALK analysed and interpreted the data. DPJV drafted the manuscript. GAPGvM, RWHMP, CMvH and MEALK advised on preparation of the manuscript. All authors contributed read, edited and approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The medical ethics committee of Maastricht University Medical Center (MUMC+) approved the study protocol (16-4-180, October 2016). The Restore4stroke study was approved by all medical-ethical committees of the participating hospitals and the Committee on Research involving Human Subjects of the St. Antonius Hospital in Nieuwegein, the Netherlands (R-10.41A, February 2011). Both studies were performed according to the Declaration of Helsinki’s principles.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.