Background and Purpose: Before developing new medical facilities or adapting existing facilities in the field of stroke, it is desirable to assess not only the medical, but also the economic consequences of such facilities. Economic evaluation studies differ from other outcome studies in the way that costs are compared with effects. The purpose of this paper is to give an insight into economic evaluation studies in the field of stroke, so that these studies become easier for neurologists to understand and to apply. Summary of the Article: Crucial aspects in economic evaluation research are addressed successively, such as the techniques used and how the results can be influenced by the perspective of the study. The article also considers the inclusion of costs and consequences in economic evaluation research. At the end of this article, special issues in economic evaluation studies are presented such as discounting, sensitivity analysis, incremental analyses and ratios. Conclusions: Although neurologists have no direct responsibility for allocating scarce resources in the field of stroke, they are confronted with the results of these decisions in their everyday work. Because of this, it might be useful to have clear understanding of economic evaluation studies and their caveats.

Bergman L, van der Meulen J, Limburg M, Habbema DF: Cost of medical care after first-ever stroke in the Netherlands. Stroke 1995;26:1830–1836.
Dobkin B: The economic impact of stroke. Neurology 1995;45:S6–S9.
Drummond MF, Ward GH: The financial burden of stroke and the economic evaluation of treatment alternatives; in Clifford Rose F (ed): Stroke: Epidemiological, Therapeutic and Socio-Economic Aspects. London, Royal Society of Medicine Services Limited, 1986, pp 147–162.
Evers SMAA, Engel GL, Ament AJHA: Cost of stroke in the Netherlands. Stroke 1997;28:1375–1381.
Forbes JF: Cost of stroke. Scott Med J 1993;38:S4–S5.
Isard PA, Forbes JF: The cost of stroke to the national service in Scotland. Cerebrovasc Dis 1992;1/2:47–50.
Scott WG, Scott H: Ischaemic stroke in New Zealand: An economic study. N Z Med J 1994;107:443–446.
Taylor TN, Davis PH, Torner JC, Holmes J, Meyer JW, Jacobson MF: Lifetime cost of stroke in the United States. Stroke 1996;27:1459–1466.
Weill C, Schneider T: The cost of cerebrovascular accidents in France in 1982; in Clifford Rose F (ed): Stroke: Epidemiological, Therapeutic and Socio-Economic Aspects. London, Royal Society of Medicine Services Limited, 1986, pp 147–162.
Detsky AS: Guidelines for economic analysis of pharmaceutical products: A draft document for Ontario and Canada. PharmacoEconomics 1993;3:354–361.
Drummond M: Australian Guidelines for Cost-Effectiveness Studies: The Thin End of the Boomerang? York, University of York, Centre for Health Economics, 1991.
Jacobs P, Bachynsky J, Baladi J-F: A comparative review of pharmacoeconomic guidelines. PharmacoEconomics 1995;8:182–189.
Maynard A, Sheldon TA: Health economics: Has it fulfilled its potential? in Maynard A, Chalmers I (eds): Non-Random Reflections on Health Services Research: On the 25th Anniversary of Archie Cochrane’s Effectiveness and Efficiency. London, BMJ Publishing Group, 1997.
Davidoff AJ, Powe NR: The role of perspective in defining economic measures for the evaluation of medical technology. Int J Technol Assess Health Care 1996;12:9–21.
Warner KE, Hutton RC: Cost-benefit and cost-effectiveness analysis in health care: Growth and composition of the literature. Med Care 1980;18:1069–1084.
Drummond MF, O’Brien B, Stoddart GL, Torrance GW: Methods for Economic Evaluation of Health Care Programmes, ed 2. Oxford, Oxford University Press, 1997.
Weinstein MC: Principles of cost-effective resource allocation in health care organization. Int J Technol Assess Health Care 1990;6:93–103.
Udvarhelyi IS, Colditz GA, Rai A, Epstein AM: Cost-effectiveness and cost-benefit analyses in the medical literature: Are the methods being used correctly? Ann Intern Med 1992;116:238–244.
Goossens MJCB, Evers SMAA: Economic assessment of back pain interventions. J Occup Rehabil 1997;7:15–32.
Evers SMAA, Wijk van AS, Ament AJHA: Economic evaluation of mental health care interventions: A review. Working Paper WP 94.03. Maastricht, University of Limburg, Department of Health Economics, 1994.
Evers SMAA, Wijk van AS, Ament AJHA: Economic evaluation of mental health care interventions: A review. Health Econ 1997;6:161–177.
Hillman AL, Eisenberg JM, Pauly MV, Bloom BS, Glick H, Kinosian B, Schwartz JS: Avoiding bias in the conduct and reporting of cost-effectiveness research sponsored by pharmaceutical companies. N Engl J Med 1991;324:1362–1365.
Freemantle N, Maynard A: Something rotten in the state of clinical and economic evaluations? Health Econ 1994;3:63–67.
Gold MR, Siegel JE, Russell LB, Weinstein MC: Cost-Effectiveness in Health and Medicine. New York, Oxford University Press, 1996.
Baltussen R, Ament A, Leidl R: Making cost assessments based on RCTs more useful to decision-makers. Health Policy 1996;37:163–183.
Rittenhouse B: Uses of Models in Economic Evaluations of Medicines and Other Health Technologies. London, Office of Health Economics, 1996.
Matchar DB, Duncan PW, Samsa GP, Whisnant JP, DeFriese GH, Ballard DJ, Paul JE, Witter DM Jr, Mitchell JP: The Stroke Prevention Patient Outcomes Research Team: Goals and methods. Stroke 1993;24:2135–2142.
Goldstein LB, Matchar DB: The Stroke P.O.R.T.: Secondary and tertiary prevention of ischemic stroke. Stroke Prevention Patient Outcomes Research Team. Health Rep 1994;6:154–159.
Matchar DB, Samsa GP, Matthews JR, Ancukiewicz M, Parmigiani G, Hasselblad V, Wolf PA, D’Agostino RB, Lipscomb J: The Stroke Prevention Policy Model: Linking evidence and clinical decisions. Ann Intern Med 1997;127:704–711.
Samsa GP, Reutter RA, Parmigiani G, Ancukiewicz M, Abrahamse P, Lipscomb J, Matchar DP: Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: Application to treatment of acute ischemic stroke. J Clin Epidemiol 1999;52:259–271.
Williams LS: Health-related quality of life outcomes in stroke. Neuroepidemiology 1998;17:116–120.
de Haan R, Horn J, Limburg M, van der Meulen J, Bossuyt P: A comparison of five stroke scales with measures of disability, handicap, and quality of life. Stroke 1993;24:1178–1181.
de Haan R, Limburg M, van der Meulen J, Jacobs HM, Aaronson NK: Quality of life after stroke: Impact of stroke type and lesion location. Stroke 1995;26:402–408.
de Haan R, Aaronson N, Limburg M, Hewer PL, van Crevel H: Measuring quality of life in stroke. Stroke 1993;24:320–327.
Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P: Is the EuroQol a valid measure of health-related quality of life after stroke? Stroke 1997;28:1876–1882.
O’Mahony P, Rodgers H, Thomson RG, Dobson R, James OF: Is the SF-36 suitable for assessing health status of older stroke patients? Age Ageing 1998;27:19–22.
Hop JW, Rinkel GJ, Algra A, van Gijn J: Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage. Stroke 1998;29:798–804.
Dorman P, Slattery J, Farrell B, Dennis M, Sandercock P: Qualitative comparison of the reliability of health status assessments with the EuroQol and SF-36 questionnaires after stroke: United Kingdom Collaborators in the International Stroke Trial. Stroke 1998;29:63–68.
van Straten A, de Haan RJ, Limburg M, Schuling J, Bossuyt PM, van den Bos GA: A stroke-adapted 30-item version of the Sickness Impact Profile to assess quality of life (SA-SIP30). Stroke 1997;28:2155–2161.
Dorman PJ, Waddell F, Slattery J, Dennis M, Sandercock P: Are proxy assessments of health status after stroke with the EuroQol questionnaire feasible, accurate, and unbiased? Stroke 1997;28:1883–1887.
Dorman PJ, Slattery J, Farrell B, Dennis MS, Sandercock PA: A randomised comparison of the EuroQol and Short Form-36 after stroke: United Kingdom collaborators in the International Stroke Trial. BMJ 1997;315:461.
Sneeuw KC, Aaronson NK, de Haan RJ, Limburg M: Assessing quality of life after stroke: The value and limitations of proxy ratings. Stroke 1997;28:1541–1549.
Hobson P, Bhowmick B, Meara J: Use of the SF-36 questionnaire in cerebrovascular disease. Stroke 1997;28:464–465.
Anderson C, Laubscher S, Burns R: Validation of the Short Form 36 (SF-36) healthy survey questionnaire among stroke patients. Stroke 1996;27:1812–1816.
Johannesson M, Jönsson B, Karlsson G: Outcome measurement in economic evaluation. Health Econ 1996;5:279–296.
Anderson DW, Rocca WA, Rosário JA: Pitfalls in neuroepidemiologic research. Neuroepidemiology 1998;17:55–62.
Sprangers MAG: Response-shift bias: A challenge to the assessment of patients’ quality of life in cancer clinical trials. Cancer Treat Rev 1996;22:55–62.
Luce B, Elixhauser A: Estimating costs in the economic evaluation of medical technologies. Int J Technol Assess Health Care 1990;6:57–75.
Dunbabin D: Cost-effective intervention in stroke. PharmacoEconomics 1992;2:468–499.
Goossens MEJB, Rutten-van Molken MPMH, Vlaeyen JWS, van der Linden SMJP: The cost diary: A method to measure the direct and indirect costs in a cost effectiveness research. J Clin Epidemiol, in press.
Luce B, Elixhauser A: Standards for Socioeconomic Evaluation of Health Care Products and Services. Berlin, Springer, 1990.
Finkler A: The distinction between cost and charges. Ann Intern Med 1982;96:102–109.
Koopmanschap MA, Ineveld van BM: Towards a new approach for estimating indirect costs of disease. Soc Sci Med 1992;34:1005–1010.
Koopmanschap MA, Rutten FFH, van Ineveld BM, van Roijen L: The friction cost method for measuring indirect cost of disease. J Health Econ 1995;14:171–179.
Drummond MF: Cost-of-illness studies a major headache? PharmacoEconomics 1992;2:1–4.
Hodgson TA, Meiners MR: Cost-of-illness methodology: A guide to current practices and procedures. Milbank Mem Fund Q/Health Soc 1982;60:429–462.
Porsdal V, Boysen G: Cost-of-illness studies of stroke. Cerebrovasc Dis 1997;7:258–263.
Drummond M, Torrance G, Mason J: Cost-effectiveness league tables: More harm than good? Soc Sci Med 1993;37:33–40.
Laupacis A, Feeny D, Detsky AS, Tugwell PX: How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evaluations. Can Med Assoc J 1992;146:473–481.
College voor Zorgverzekeringen: Richtlijnen voor farmaco-economisch onderzoek. Amstelveen, College voor Zorgverzekeringen, 1999.
Mullins CD, Ogilvie S: Emerging standardization in pharmacoeconomics. Clin Ther 1998;20:1194–1202.
Detsky AS, Naglie G: A clinician’s guide to cost-effectiveness. Ann Intern Med 1990;113:147–154.
Smurawska LT, Alexandrov AV, Bladin CF, Norris JW: Cost of Acute Stroke Care in Toronto, Canada. Stroke 1994;25:1628–1631.
Terent A, Marke LA, Asplund K, Norrving B, Jonsson E, Wester PO: Costs of stroke in Sweden: A national perspective. Stroke 1994;25:2363–2369.
Magnusson S, Werkö L (eds): Stroke, Stockholm, The Swedish Council on Technology Assessment in Health Care, 1992, chapter 12: Economics, pp 94–102.
Thorngren M, Westling B: Utilization of health care resources after stroke: A population-based study of 258 hospitalized cases followed during the first year. Acta Neurol Scand 1991;84:303–310.
OECD: OECD Statistical Compendium. Paris, Data Service Information and the OECD, 1996.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.