Disease Burden Of Patients With Stroke And Economic Evaluation On Community-Based Prevention Strategies For Stroke In Xinhua Community, Shanghai

BackgroundStroke severely threatens human being's health for its high incidence rate, mortality rate and handicap-causing rate.Enormous studies showed that the primary prevention in communities can effectively decrease the incidence and mortality of stroke.Hypertension is not only a single disease but also an important risk factor of cardiovascular diseases,so the control of hypertension is important to prevent stroke. Studies have indicated that the blood pressure level in population could be declined through developing community-based comprehensive program on prevention of hypertension.To decide whether the intervention programme is worth of implementation,only the effect evaluation is not enough,health economic analyses should also be performed.However,there are few studies in this field in China.To prevent stroke,the long-term strategy of hypertension management had been taken to control the rise of risk factors among the people in Xinhua Community,in other words,to aim directly at the cause of the diseases,involving community-based strategy and high-risk group strategy.Under this circumstance,it is important and necessary to measure disease burden of stroke and conduct economic evaluation on community-based strategies for stroke and provide scientific evidence,which is helpful not only to identify effective interventions,but also to enrich study of hypertension prevention and control system.ObjectivesGeneral goal of the present study was to evaluate the disease and economic burden of stroke on community-based project for stroke prevention.As a result,it would provide scientific evidence for policy-makers to develop a cost-effective and feasible strategy to prevent stroke.The specific objectives are as follows:1.To measure the disease burden and the economic burden of stroke;2.To evaluate the impact of community-based strategies for stroke;3.To compare and analyze cost-effectiveness of community-based strategies for stroke by using Markov model.4.To summarize the experience of this intervention programme for finding suitable methods to further intervention.Methods1.Diseases burden methods:Death database from CDC and population data was used to evaluate mortality,years of life lost with premature death(YLLs) and disability adjusted life years(DALYs) in Xinhua Community.2.Diseases economic burden methods:Researchers investigated in stroke patients in Xinhua Community of Shanghai.The direct economic burden is measured by bottom-up approach,indirect economic burden by the human capital method combining with DALYs,and the intangible burden by 'willingness to pay' method.3.Impact evaluation:Pre-and post-design was conducted using repeated cross-sectional surveys and monitor data in community and death data from the local center for disease control(CDC).4.Economic appraisal of community-based strategies for stroke:Cost effectiveness analysis and cost benefit analysis on community-based strategies were conducted through developing a Markov model to simulate expected health outcomes of 10000 people based on the results of field surveys and literature reviews.5.Qualitative research:Interviewees and literature reviews was adopted to discuss the feasibility of community-based strategiesMain findings1.Burden of disease of stroke:Proportion of death due to stroke is 19%.The crude and standard mortality rates of stroke per year among people older than 35 years were 193.36/100,000,128.07/100,000(world standard population) and 155.99/100,000(shanghai population),respectively.The average YLLs and DALYs of stroke above 35 years were 19.67 and 24.59 per 1000 persons.35.4% of patients with stroke were disabled.The direct cost per capita in Xinhua Community wasï¿¥12752.The payment rates of patients were 41%of the direct cost and 44%of their income.The indirect burden and intangible burden wereï¿¥11417 andï¿¥134143,respectively.The total economic burden was estimatedï¿¥24169.2.The comprehensive community prevention approach was effective in the prevention and control of stroke.After long-term intervention,significant improvement was found in the prevalence of awareness,treatment and control of hypertension.The morbidity and mortality of stroke as well as DALYs were significantly decreased.3.Economic evaluation.Compared with no intervention,6574 life years(LYs) and 6303 quality adjusted life year quality life years(QALYs) were gained with intervention,while 998 persons were free of stroke for the cohort of 10000 people 35 years old over a 50-year period.Markov cohort analysis showed that, the average cost-effectiveness isï¿¥259 per LYs andï¿¥261 per QALYs in community-based strategy,whileï¿¥230 per LYs andï¿¥231 per QALYs in no strategy.In order to avoid 1 patient with stroke,community-based strategy will spendï¿¥8547 more than that of no strategy,while it will spendï¿¥1296 per LYs andï¿¥1353 per QALYs more.Community-based strategy should be considered as priority.4.If greater emphasis was placed on hypertension incidence,the cost of hypertension medication and management could be lowered down,economic effectiveness of community-based strategy will be improved greatly.5.The long-term strategy of hypertension control in Xinhua Community involving community-based strategy and high-risk group strategy is feasible,but the investment for study program approach is not suited for other community.6.Greater emphasis should be placed on hypertension's primary prevention, reasonable use of hypertensive's drugs as well as behavior intervention.Main conclusions1.The disease and economic burden caused by stroke was dramatically higher. Effective measures of community-based strategy should be taken to reduce and avoid stroke.2.Community-based strategy was feasible and effective in the prevention and control of stroke,and it should be considered as priority.3.More attention should be attached to comprehensive factors intervention for hypertension,the lower cost of hypertension medication fee and management cost. Contributions of this study1.The study firstly carried out an economic appraisal on community-based strategies for stroke systematically using Markov model in China.2.Markov time-dependent model was firstly used with community field surveys to make decisions in China.3.The study conducted cost-effectiveness analysis in community-based stroke prevention with QALYs and costs from social perspective,and it measured the burden of disease with mortality and DALYs,meanwhile measuring economic burden systematically.