# Development, Validation, and Application of a Stroke Policy Simulation Model

> **NIH NIH R01** · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2022 · $477,686

## Abstract

Stroke is a leading cause of mortality, morbidity, and healthcare costs in the U.S., but there are
tradeoffs associated with tackling each of these dimensions. For example, expanding screening for
stroke-specific risk factors to the general population could identify high-risk individuals who might
benefit from intensive stroke prevention measures, such as high-dose medical management or
revascularization procedures, but these interventions also carry treatment risks and increase the costs
of stroke care. Similarly, quality targets can help providers improve stroke care, but excessive quality
measurement can be inefficient. Specifically, the American Stroke Association (ASA) has endorsed 15
key acute stroke performance measures that aim to improve the quality of stroke care, but the
inefficient amount of time and money spent on excessive quality measurement could ultimately detract
from the positive impact that could be realized by prioritizing a smaller number of the most cost-
effective measures. These tradeoffs among long-term health benefits, risks, and costs of stroke
prevention or quality improvement strategies can best be quantified using disease simulation modeling
techniques and cost-effectiveness analysis. We propose to identify cost-effective stroke policies by
developing, validating, and applying simulation modeling. Our study has the following aims: 1) Develop
and validate a computer-based stroke policy micro-simulation model. We will model the natural history
of stroke disease progression and medical treatments to project lifetime health benefits and healthcare
costs accrued for a representative U.S. model population, and validate our model results to publicly
available datasets from NHANES and NIH-funded cohort studies; 2) Apply the simulation model to
evaluate the cost-effectiveness of stroke prevention policies, focusing on targeted and/or staged
screening for carotid stenosis and atrial fibrillation. We will use our model to evaluate targeted and
staged screening strategies, in addition to no screening or broad population screening strategies, for
these stroke risk factors; 3) Apply the simulation model to evaluate the cost-effectiveness of the ASA’s
15 proposed acute ischemic stroke quality measures. Our goal for this aim is to reduce the complexity
of stroke quality measurement by identifying the highest value 3-5 provider benchmarks as defined by
cost-effectiveness analysis. Our flexible simulation modeling approach will be able to adapt to changes
in stroke prevention and treatment paradigms, a feature which is not possible in longitudinal clinical trial
study designs. We expect our proposed research will provide healthcare decision-makers with a set of
evidence-based policy actions that will prevent more strokes in the general population and efficiently
prioritize the use of life-saving treatments in acute stroke patients, all while curbing cost-ineffective
stroke care utilization, which not only wastes money but can cause a...

## Key facts

- **NIH application ID:** 10429927
- **Project number:** 5R01NS104143-05
- **Recipient organization:** HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
- **Principal Investigator:** Ankur Pandya
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $477,686
- **Award type:** 5
- **Project period:** 2018-08-15 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10429927

## Citation

> US National Institutes of Health, RePORTER application 10429927, Development, Validation, and Application of a Stroke Policy Simulation Model (5R01NS104143-05). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10429927. Licensed CC0.

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