1
|
Ramamoorthy V, Appunni S, Roy M, Saxena A, Rubens M. In reply to the Letter to the Editor regarding: Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107429. [PMID: 37866986 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
| | | | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
| |
Collapse
|
2
|
Gupta AK, Kaur K, Bhatia L, Kaur R, Bhaskar A, Singh G. Causes of Pre-hospital Delay in Acute Stroke in Punjab. Cureus 2023; 15:e39180. [PMID: 37332445 PMCID: PMC10276577 DOI: 10.7759/cureus.39180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/20/2023] Open
Abstract
Background Pre-hospital delay, which refers to the time delay between the development of symptoms in the patient and the start of treatment, is one of the major factors impacting the treatment of stroke. This study aimed to identify patient characteristics and factors causing a pre-hospital delay in acute stroke (both ischemic and hemorrhagic) cases. Methodology This prospective follow-up study included 100 patients who presented with clinical features of acute stroke within 48 hours of symptom onset. A pre-designed questionnaire was administered within 72 hours of hospital admission to every patient. Results The mean time to hospital presentation was 7.73 hours. Only 2% of patients were thrombolysed. Age group, gender, education status, occupation, and socioeconomic status were not significantly (p > 0.05) associated with the mean symptom onset time to hospital arrival. Rural area (p < 0.001), nuclear family (p = 0.004), distance from the tertiary care center (p < 0.001), being alone at the time of symptom onset (p < 0.001), lack of knowledge about symptoms of stroke in patient/attendant (p < 0.001), and mode of transport were the factors that emerged as significant predictors of pre-hospital delay on univariate analysis. Living in a nuclear family, distance from the tertiary care center, and mode of transport were the factors that emerged as independent predictors of pre-hospital delay on multiple linear regression analysis. Conclusions In this study, factors associated with delayed hospital presentation including living in a nuclear family, distance from the tertiary care center, and use of public transport to reach the hospital emerged as independent predictors of pre-hospital delay.
Collapse
Affiliation(s)
- Amit Kumar Gupta
- Department of Cardiology, Dayanand Medical College & Hospital, Ludhiana, Ludhiana, IND
| | - Kamaldeep Kaur
- Department of Medicine, Government Medical College and Rajindra Hospital Patiala, Patiala, IND
| | - Lovleen Bhatia
- Department of Medicine, Government Medical College, Patiala, Patiala, IND
| | - Rupinderjeet Kaur
- Department of Medicine, Government Medical College, Patiala, Patiala, IND
| | - Ajay Bhaskar
- Department of Medicine, Government Medical College, Patiala, Patiala, IND
| | - Gurpreet Singh
- Department of Medicine, Government Medical College, Patiala, Patiala, IND
| |
Collapse
|
3
|
Nguyen CP, Maas WJ, van der Zee DJ, Uyttenboogaart M, Buskens E, Lahr MMH. Cost-effectiveness of improvement strategies for reperfusion treatments in acute ischemic stroke: a systematic review. BMC Health Serv Res 2023; 23:315. [PMID: 36998011 PMCID: PMC10064746 DOI: 10.1186/s12913-023-09310-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/20/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Reducing delays along the acute stroke pathway significantly improves clinical outcomes for acute ischemic stroke patients eligible for reperfusion treatments. The economic impact of different strategies reducing onset to treatment (OTT) is crucial information for stakeholders in acute stroke management. This systematic review aimed to provide an overview on the cost-effectiveness of several strategies to reduce OTT. METHODS A comprehensive literature search was conducted in EMBASE, PubMed, and Web of Science until January 2022. Studies were included if they reported 1/ stroke patients treated with intravenous thrombolysis and/or endovascular thrombectomy, 2/ full economic evaluation, and 3/ strategies to reduce OTT. The Consolidated Health Economic Evaluation Reporting Standards statement was applied to assess the reporting quality. RESULTS Twenty studies met the inclusion criteria, of which thirteen were based on cost-utility analysis with the incremental cost-effectiveness ratio per quality-adjusted life year gained as the primary outcome. Studies were performed in twelve countries focusing on four main strategies: educational interventions, organizational models, healthcare delivery infrastructure, and workflow improvements. Sixteen studies showed that the strategies concerning educational interventions, telemedicine between hospitals, mobile stroke units, and workflow improvements, were cost-effective in different settings. The healthcare perspective was predominantly used, and the most common types of models were decision trees, Markov models and simulation models. Overall, fourteen studies were rated as having high reporting quality (79%-94%). CONCLUSIONS A wide range of strategies aimed at reducing OTT is cost-effective in acute stroke care treatment. Existing pathways and local characteristics need to be taken along in assessing proposed improvements.
Collapse
Affiliation(s)
- Chi Phuong Nguyen
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands.
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam.
| | - Willemijn J Maas
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Durk-Jouke van der Zee
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten Uyttenboogaart
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Radiology, Medical Imaging Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik Buskens
- Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Maarten M H Lahr
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|