Cost-Effectiveness of a Structured Case Management Program for Transient Ischemic Attack Patients in Germany

OBJECTIVES: Transient ischemic attacks (TIA) often indicate a high risk of subsequent cerebral ischemic events, which are linked to increased disability, assistance needs, and elevated healthcare and societal costs. This study assesses the cost-effectiveness of a structured case management program (CMP) in preventing further strokes in comparison to the standard of care (SOC) in Germany, where cross-sectoral aftercare remains a challenge despite high inpatient care standards.

METHODS: A cost-effectiveness model was developed to simulate the life course of a hypothetical cohort of 72-year-old individuals following their first TIA. This cohort was analyzed under two scenarios: receiving the CMP or SOC. The model assessed accumulated costs and quality-adjusted life years (QALYs) for each scenario. Stroke occurrence rates in the SOC scenario were informed by Kaplan-Meier curves to which parametric survival models were fitted. The effectiveness of the CMP was informed by the hazard ratio for stroke recurrence within one year post-TIA from a German study. The analysis was performed from the perspective of the German healthcare system with costs and effects discounted at 3% annually.

RESULTS: The deterministic analysis estimated that the CMP resulted in a gain of 0.36 QALYs per patient and cost savings of €2,218 compared to SOC, leading to an incremental cost-effectiveness ratio (ICER) of -€6,179 per QALY. Probabilistic sensitivity analysis (PSA) showed a mean gain of 0.32 QALYs and cost savings of €1,360, with a probabilistic ICER of -€4,242 per QALY. Approximately 80% of PSA simulations fell within the south-east quadrant, with a minority in the north-west quadrant.

CONCLUSIONS: The CMP for TIA patients appears to offer potential cost savings and health benefits compared to SOC. However, given the variability in the probabilistic cost-effectiveness results, with some simulations indicating increased costs and reduced benefits, the value of further research should be assessed through a value of information analysis.