Please cite this article in press as: Cadilhac DA, et al., Why invest in a national public health program for stroke?, Health Policy (2007), doi:10.1016/j.healthpol.2007.02.001 ARTICLE IN PRESS HEAP-1997; No. of Pages 8 Health Policy xxx (2007) xxx–xxx Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications Dominique A. Cadilhac a,b,c,∗ , Robert C. Carter f , Amanda G. Thrift g,e , Helen M. Dewey a,b,d a National Stroke Research Institute, Heidelberg Heights, Vic. 3081, Australia b Department of Medicine, The University of Melbourne, 3010, Australia c School of Population Health, The University of Melbourne, 3010, Australia d Department of Neurology, Austin Health, Heidelberg 3084, Australia e Department Epidemiology & Preventive Medicine, Monash University, Prahran, Australia f Deakin Health Economics Unit, School of Health and Social Development, Deakin University, Burwood Vic 3125, Australia g Population Health Research, Baker Heart Research Institute, Melbourne 8008, Australia Abstract Objectives: Stroke is the world’s second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money. Methods: Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews. Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered. Results: Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion. Conclusions: Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted. © 2007 Elsevier Ireland Ltd. All rights reserved. Keywords: Stroke; Health policy; Economics; Outcomes ∗ Corresponding author at: National Stroke Research Institute, Level 1 Neurosciences Building, Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Vic. 3081, Australia. Tel.: +61 3 9496 2078; fax: +61 3 9496 2650. E-mail address: dcadilhac@nsri.org.au (D.A. Cadilhac). 0168-8510/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.healthpol.2007.02.001