The lifetime health-adjusted survival of stroke patients.

<p>The survival probability (longdash line) multiplied by the proportion of patients with no disability (dotted line) over time after diagnosis results in the health-adjusted survival curve (solid line), which can be summed to estimate the expected life years without functional disabilities for stroke patients (shaded area).</p

Dynamic changes in functional needs for patients with severe disabilities after stroke.

<p>Dynamic changes in functional needs for patients with severe disabilities after stroke.</p

Estimation of life expectancy (LE, 95% confidence interval (CI), in years), EYLL (expected years of life loss, with standard error of mean in parenthesis), mean lifelong duration (95% CI, in years) of each functional disability state as measured by the Barthel Index (BI) and EYLD (expected years of living with disability) stratified by different stroke subtypes.

*<p>no disability (BI = 100);</p>†<p>mild disability (BI = 90–95);</p>‡<p>moderate disability (BI = 60–85);</p>§<p>severe disability (BI = ≤55);</p>| |<p>LAA:Large artery atherothrombosis;</p>#<p>CE: Cardio-embolism;</p>**<p>ICH: Intracerebral hemorrhage.</p

Mean (standard error, in years) duration of subjects with different levels and types of functional disabilities, as measured by the Barthel Index (BI) and stratified by stroke subtypes.

*<p>LAA: Large artery atherothrombosis;</p>†<p>CE: Cardio-embolism;</p>‡<p>ICH: Intracerebral hemorrhage.</p

Comparison of frequency distributions of stroke patients hospitalized under the National Health Insurance (NHI), at the National Taiwan University Hospital (NTUH), and a cross-sectional sample at the stroke clinics and rehabilitation wards.

*<p>P<0.001;</p>†<p>SD: standard deviation.</p

Cost per QALY (Quality-Adjusted Life Year) and Lifetime Cost of Prolonged Mechanical Ventilation in Taiwan

<div><h3>Introduction</h3><p>Patients who require prolonged mechanical ventilation (PMV) are increasing and producing financial burdens worldwide. This study determines the cost per QALY (quality-adjusted life year), out-of-pocket expenses, and lifetime costs for PMV patients stratified by underlying diseases and cognition levels.</p> <h3>Methods</h3><p>A nationwide sample of 50,481 patients with continual mechanical ventilation for more than 21 days was collected during 1997–2007. After stratifying the patients according to specific diagnoses, a latent class analysis (LCA) was performed to categorise PMV patients with multiple co-morbidities into several homogeneous groups. The survival functions were estimated for individual groups using the Kaplan-Meier method and extrapolated to 300 months through a semi-parametric method. The survival functions were adjusted using an EQ-5D utility value derived from a convenience sample of 142 PMV patients to estimate quality-adjusted life expectancies (QALE). Another convenience sample of 165 patients was used to estimate the out-of-pocket expenses. The lifetime expenditures paid by the single-payer National Health Insurance (NHI) system and patients' families were estimated by multiplying average monthly expenditures by the survival probabilities and summing the values over lifetime.</p> <h3>Results</h3><p>PMV therapy costs more than 100,000 U.S. dollars (USD) per QALY for all patients with poor cognition. For patients with partial cognition, PMV therapy costs less than 56,000 USD per QALY for those with liver cirrhosis, intracranial or spinal cord injuries, and 57,000–69,000 USD for patients with multiple co-morbidities under age of 65. The average lifetime cost of PMV was usually below 56,000 USD. The out-of-pocket expenses were often more than one-third of the total cost of treatment.</p> <h3>Conclusions</h3><p>PMV treatment for patients with poor cognition would cost more than 5 times Taiwan's GDP (gross domestic products), or less cost-effective. The out-of-pocket expenses for PMV provision should also be considered in policy decision.</p> </div

Lifetime cost and cost per QALY (quality-adjusted life year) for patients undergoing prolonged mechanical ventilation in Taiwan, stratified by underlying diseases (Dis.), with sensitivity analysis of quality-adjusted life expectancy (QALE) under different states of cognition.

*<p>SE: standard error of the mean.</p>†<p>Dis. : diseases.</p

Flow chart of the computation process for lifetime costs and cost-per-QALY (quality-adjusted life year).

<p>Flow chart of the computation process for lifetime costs and cost-per-QALY (quality-adjusted life year).</p

The average lifetime healthcare expenditure paid by the National Health Insurance (NHI) for patients undergoing PMV.

<p>(prolonged mechanical ventilation) was calculated by multiplying the monthly average paid by the NHI (N = 50,481) with the corresponding survival probability and then summed up throughout life, as indicated by the shaded areas of the upper panel. The lifetime out-of pocket expense for PMV patients was obtained by multiplying the monthly average out-of pocket expense (estimated by kernel smoothing method on a convenient sample of 165 patients) with the corresponding survival probability and then summed up (shaded areas of the lower panel). The expected lifetime cost of a PMV patient is the total sum of these two shaded areas.</p

Quality adjusted survival for patients undergoing PMV (prolonged mechanical ventilation) with partial cognition after adjustment for survival function (N = 50,481) with the utility values of quality of life measured with EQ-5D (N = 55).

<p>The result of QALE (quality-adjusted life expectancy) of an average patient was 0.98 QALY by summing the areas under the quality-adjusted survival curve.</p