Health and economic benefits of improving pre-hospital identification of stroke in Australian women: a modelling study

Objective: To estimate the long term gains in life years and quality-adjusted life years (QALYs) and the cost savings that could be achieved if ischaemic stroke was identified in women with the same level of accuracy received by men, versus the status quo. Design: Decision tree and Markov model decision analysis. Settings, participants: Two arms including 5513 women aged under 70 years: a hypothetical scenario, in which women receive the same level of accuracy of stroke identification as men (yet experienced symptoms relevant to women); and the status quo. Transitions between post-stroke health states, recurrent stroke and death were made in 1-year cycles over 50 years from a societal perspective. Main outcome measures: Years of life lived, QALYs and costs per patient in the hypothetical scenario relative to the status quo. Results were extrapolated to the national level based on the annual number of ischaemic stroke hospitalisations among women across Australia in the financial year 2020–21. Results: Compared with the status quo, the hypothetical arm gained 0.14 years of life, gained 0.08 QALYs and saved $2984 per patient. At the national level, for the financial year 2020–21, this equates to 252 life years and 144 QALYs gained, and cost savings of $5.4 million. Outcomes were most sensitive to the probability of an accurate assessment of stroke, short term treatment costs, patient age, and transition probabilities to 90-day post-stroke health states. Conclusions: Enhancing the timely and accurate identification of ischaemic stroke among Australian women in the pre-hospital setting would yield significant health benefits and cost savings to Australian society as a whole.