ESO East Supplement 2023 - 22

22
European Stroke Journal 8(1S)
Life Year) index was performed to include quality of life
data in the model via previously published studies.10,11
The health economic model is comprised of a one-year
discrete event simulation (DES) mapping the patient experience
with the Croatian health care system, built from a
combination of expert opinion, Croatian health care data
and a 10-year long term Markov model building on existing
literature. Recurrent stroke cycles places patients back into
the DES model. This is in line with previous similar studies
which have used 90 days and 5 year DES modelling and
patient registry analysis to construct similar outcome models.12,13
For this study, the first year following a stroke event
was chosen as the period for the first stage of the model;
this greatly simplifies the analysis as by the end of the first
year all patients can be categorised into one of just a few
states.
Figure 1. Patient pathways.
indices.8,9 RES-Q was developed, and launched in 2016,
and has been used to collect data from over 90,000 patients
from >750 hospitals and 56 countries between September
2016 and May 2019. It contained questions related to 28
metrics for ischaemic stroke, intracerebral haemorrhage,
subarachnoid haemorrhage and cerebral venous thrombosis.8
This registry may be used for outcome valuation and
quality improvement.8 However, the registry does not
measure health care costs nor are such registries designed
to measure the value provided by the health care system.
The aim of this analysis was to estimate 1 year and longterm
cost and quality of life of ischaemic stroke patients in
Croatia. In addition we aimed to identify and estimate key
categories of costs and outcomes driving the burden of
stroke in Croatian healthcare system.
Methods
The analysis was performed in three stages. First, the health
economic model was constructed form clinical opinion and
literature to map a care pathway for stroke patients. Then,
the data from the RES-Q and literature was used to populate
the probabilities and the data from the DRG codes and
health care tariffs was used to populate costs. Further, mapping
of the Barthel Index to the QALY (Quality Adjusted
Input parameters for the first year of stroke were derived
from analysis of the RES-Q for Croatia entered during 2018
(578 stroke patients during 2018) by Budinčević et al.14
Data on demographics, stroke care pathway, specific acute
treatment issues, stroke prevention issues in all acute stroke
admissions in Croatia were analysed in the study. Thirteen
out of twenty-three acute hospitals with stroke units which
provide stroke treatment recruited 578 patients for 2018
year. Most of the hospitals entered data during March, two
hospitals entered data during February and March, and a
hospital entered data for November and December.14 The
registry data were analysed in close collaboration with the
clinicians involved to support the design of our health economic
model. The model follows a natural course of disease
and treatment patterns in Croatian health care system
for ischaemic stroke. The identified patient pathways were
then matched to Croatian DRG codes (the DRG codes represent
costing system based on events of hospitalisation) to
provide for the costs of first year.12
Results
In total, 17 distinct paths of patient care were identified. All
of which begin with ischaemic stroke followed by admission
at the emergency unit and ended with patients returning
home, entering rehabilitation or residential care, or
dying. The final patient pathways are presented in Figure 1.
Not all pathways had the required data to estimate the
probabilities associated with a particular outcome.
Unknown probabilities were solved using a simple genetic
algorithm approach, such that the proportion of patients
travelling down each pathway matched the distribution of
patients in the appropriate DRG group recorded by the hospital
and public data and discharge destination recorded in
the registry, the results of this calculation can be seen in
Table 1.
Croatian hospitals use four discrete DRG codes, no
HrQoL data was included in the registry. Previous HrQoL
research has already established the relationship between
ESO East Supplement 2023

Table of Contents for the Digital Edition of ESO East Supplement 2023
