A Systematic Review of Economic Models in Stroke Care Pathways

Background: the importance of evidence-based care pathways in stroke have been highlighted by recently published national guidelines. However, little research has focused on identifying which components of the care pathway are cost-effective. Objectives: To search the published literature to identify approaches that would circumvent methodological problems and allow economic evaluations of stroke care pathways. Methods: eight literature databases were searched for studies from 1999 to Feb 2010 using standard health economic evaluation terms, stroke terms and terms relating to care pathways and care processes. Studies reporting evaluations of more than one stroke care process concurrently were considered for review. Results: Very few studies met the inclusion criteria as most evaluations focused on discrete, individual interventions. Five studies were selected for review. The most promising approach to care pathway analysis using traditional modelling was to alter parameters for individual care processes and observe the impact on care pathway output. A promising alternative approach was discrete event simulation of the whole care pathway which allows representation of timing and competition for resources. Conclusions: cost-effectiveness of individual care processes should be established to aid distribution of resources effectively along the pathway. A comparison of Markov and simulation modelling in stroke is required to determine the most appropriate approach for analysing the care pathway.