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Venketasubramanian N. Stroke Epidemiology in Oceania: A Review. Neuroepidemiology 2021; 55:1-10. [PMID: 33601397 DOI: 10.1159/000512972] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 11/11/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Oceania, comprising the regions Australasia, Melanesia, Micronesia, and Polynesia, is home to 42 million living in 8.5 million square kilometres of land. This paper comprises a review of the epidemiology of stroke in countries in this region. METHODS Information on epidemiology of stroke in Oceania was sought from data from the Global Burden of Disease (GBD) study (incidence, mortality, incidence:mortality ratio [IMR], prevalence, disability-adjusted life-years [DALYs] lost due to stroke, and subtypes), World Health Organization (WHO) (vascular risk factors in the community), and PubMed (incidence, prevalence, and stroke subtypes). Data were analyzed by region to allow inter-country comparison within each region. RESULTS In 2010, age- and sex-standardized stroke mortality rates were lowest in Australasia (29.85-31.67/100,000) and highest in Melanesia and Micronesia (56.04-187.56/100,000), with wide ranges especially in Melanesia. Incidence rates were lowest in Australasia (101.36-105.54/100,000), similarly high elsewhere. Standardized IMR (0.98-3.39) was the inverse of the mortality rates and mirrored the prevalence rates (202.91-522.29/100,000). DALY rates (398.22-3,781.78/100,0000) mirrored the mortality rates. Stroke risk factors show a variable pattern - hypertension is generally the most common medical risk factor among males (18.0-26.6%), while among females, diabetes mellitus is the most common in Micronesia and Polynesia (21.5-28.4%). Among the lifestyle factors, current smoking is the most common in Melanesia among males, while obesity is generally the most common factor among females. Ischaemic stroke comprises 70% of stroke subtypes. Trend data show significant falls in standardized mortality rates and DALYs in most regions and falls in incidence in almost all countries. There is significant economic impact, particularly due to young strokes; some ethnicities are at higher risk than others, for example, Maoris and Pacific Islanders. CONCLUSIONS Stroke is a major healthcare problem in Oceania. Variations in stroke epidemiology are found between countries in Oceania. Data are lacking in some; more research into the burden of stroke in Oceania is needed. With the expected increase in life expectancy and vascular risk factors, the burden of stroke in Oceania will likely rise. Some of the disparities in stroke burden may be addressed by great investment in healthcare.
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Feigin VL, Krishnamurthi R, Barker-Collo S, Barber PA, Rathnasabapathy Y, Te Ao B, Parmar P, Mahon S, Tunnage B, Swain A, Arroll B, Elder H, Tautolo ES, Parag V, Anderson C, Bennett D, Thrift AG, Cadilhac DA, Brown P, Ranta A, Douwes J. Measuring stroke and transient ischemic attack burden in New Zealand: Protocol for the fifth Auckland Regional Community Stroke Study (ARCOS V). Int J Stroke 2019; 15:573-583. [PMID: 31648621 DOI: 10.1177/1747493019884528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim: The goal of this paper is to provide a protocol for conducting a fifth population-based Auckland Regional Community Stroke study (ARCOS V) in New Zealand. Methods and Discussion: In this study, for the first time globally, (1) stroke and TIA burden will be determined using the currently used clinical and tissue-based definition of stroke, in addition to the WHO clinical classifications of stroke used in all previous ARCOS studies, as well as more advanced criteria recently suggested for an "ideal" population-based stroke incidence and outcomes study; and (2) age, sex, and ethnic-specific trends in stroke incidence and outcomes will be determined over the last four decades, including changes in the incidence of acute cerebrovascular events over the last decade. Furthermore, information at four time points over a 40-year period will allow the assessment of effects of recent changes such as implementation of the FAST campaign, ambulance pre-notification, and endovascular treatment. This will enable more accurate projections for health service planning and delivery. Conclusion: The methods of this study will provide a foundation for future similar population-based studies in other countries and populations.
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Affiliation(s)
- Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Rita Krishnamurthi
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | | | - P Alan Barber
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Braden Te Ao
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Priya Parmar
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Susan Mahon
- Department of Paramedicine, University of Auckland, Auckland, New Zealand
| | - Bronwyn Tunnage
- Department of Paramedicine, University of Auckland, Auckland, New Zealand
| | - Andrew Swain
- Department of Paramedicine, University of Auckland, Auckland, New Zealand
| | - Bruce Arroll
- School of Public Health, University of Auckland, Auckland, New Zealand
| | - Hinemoa Elder
- Brain Research New Zealand Centre of Research Excellence, Auckland, New Zealand
| | - El-Shadan Tautolo
- Centre for Pacific Health & Development Research and Pacific Islands Families, Auckland University of Technology, Auckland, New Zealand
| | - Varsha Parag
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Craig Anderson
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Derrick Bennett
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amanda G Thrift
- Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - Dominique A Cadilhac
- Stroke Division, Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Victoria, Australia
| | - Paul Brown
- University of California Merced, Merced, CA, USA
| | - Annemarei Ranta
- Department of Medicine, University of Otago, Wellington, New Zealand
| | - Jeroen Douwes
- Centre for Public Health Research, Massey University, Wellington, New Zealand
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Wilson N, Davies A, Brewer N, Nghiem N, Cobiac L, Blakely T. Can cost-effectiveness results be combined into a coherent league table? Case study from one high-income country. Popul Health Metr 2019; 17:10. [PMID: 31382954 PMCID: PMC6683509 DOI: 10.1186/s12963-019-0192-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 07/23/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Doubts exist around the value of compiling league tables for cost-effectiveness results for health interventions, primarily due to methods differences. We aimed to determine if a reasonably coherent league table could be compiled using published studies for one high-income country: New Zealand (NZ). METHODS Literature searches were conducted to identify NZ-relevant studies published in the peer-reviewed journal literature between 1 January 2010 and 8 October 2017. Only studies with the following metrics were included: cost per quality-adjusted life-year or disability-adjusted life-year or life-year (QALY/DALY/LY). Key study features were abstracted and a summary league table produced which classified the studies in terms of cost-effectiveness. RESULTS A total of 21 cost-effectiveness studies which met the inclusion criteria were identified. There were some large methodological differences between the studies, particularly in the time horizon (1 year to lifetime) but also discount rates (range 0 to 10%). Nevertheless, we were able to group the incremental cost-effectiveness ratios (ICERs) into general categories of being reported as cost-saving (19%), cost-effective (71%), and not cost-effective (10%). The median ICER (adjusted to 2017 NZ$) was ~ $5000 per QALY/DALY/LY (~US$3500). However, for some interventions, there is high uncertainty around the intervention effectiveness and declining adherence over time. CONCLUSIONS It seemed possible to produce a reasonably coherent league table for the ICER values from different studies (within broad groupings) in this high-income country. Most interventions were cost-effective and a fifth were cost-saving. Nevertheless, study methodologies did vary widely and researchers need to pay more attention to using standardised methods that allow their results to be included in future league tables.
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Affiliation(s)
- Nick Wilson
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Anna Davies
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Naomi Brewer
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Nhung Nghiem
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Linda Cobiac
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Tony Blakely
- BODE³ Programme, Department of Public Health, University of Otago Wellington, Wellington, New Zealand
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Joo H, Wang G, George MG. A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischemic stroke. Stroke Vasc Neurol 2017; 2:73-83. [PMID: 28736623 PMCID: PMC5516524 DOI: 10.1136/svn-2016-000063] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. AIMS To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times. SUMMARY OF REVIEW A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the key words acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving, and incremental cost-effectiveness analysis. The review is limited to original research articles published during 1995-2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 2 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective. CONCLUSIONS The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.
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Affiliation(s)
- Heesoo Joo
- Division for Heart Disease and Stroke Prevention, CDC; IHRC Inc., Atlanta, Georgia, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, USA
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, USA
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