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Abreu P, Correia M, Azevedo E, Sousa-Pinto B, Magalhães R. Rapid systematic review of readmissions costs after stroke. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:22. [PMID: 38475856 DOI: 10.1186/s12962-024-00518-3] [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: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Stroke readmissions are considered a marker of health quality and may pose a burden to healthcare systems. However, information on the costs of post-stroke readmissions has not been systematically reviewed. OBJECTIVES To systematically review information about the costs of hospital readmissions of patients whose primary diagnosis in the index admission was a stroke. METHODS A rapid systematic review was performed on studies reporting post-stroke readmission costs in EMBASE, MEDLINE, and Web of Science up to June 2021. Relevant data were extracted and presented by readmission and stroke type. The original study's currency values were converted to 2021 US dollars based on the purchasing power parity for gross domestic product. The reporting quality of each of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Forty-four studies were identified. Considerable variability in readmission costs was observed among countries, readmissions, stroke types, and durations of the follow-up period. The UK and the USA were the countries reporting the highest readmission costs. In the first year of follow-up, stroke readmission costs accounted for 2.1-23.4%, of direct costs and 3.3-21% of total costs. Among the included studies, only one identified predictors of readmission costs. CONCLUSION Our review showed great variability in readmission costs, mainly due to differences in study design, countries and health services, follow-up duration, and reported readmission data. The results of this study can be used to inform policymakers and healthcare providers about the burden of stroke readmissions. Future studies should not solely focus on improving data standardization but should also prioritize the identification of stroke readmission cost predictors.
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Affiliation(s)
- Pedro Abreu
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Correia
- Department of Neurology, Hospital Santo António- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Cao X, Li R, Tang W, Wang W, Ji J, Yin C, Niu L, Gao Y, Ma Q. How health risk factors affect inpatient costs among adults with stroke in China: the mediating role of length of stay. BMC Geriatr 2024; 24:131. [PMID: 38373895 PMCID: PMC10877923 DOI: 10.1186/s12877-024-04656-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND As stroke has become the leading cause of death and disability in China, it has induced a heavy disease burden on society, families, and patients. Despite much attention within the literature, the effect of multiple risk factors on length of stay (LOS) and inpatient costs in China is still not fully understood. AIM To analyse the association between the number of risk factors combined and inpatient costs among adults with stroke and explore the mediating effect of LOS on inpatient costs. METHODS A retrospective cross-sectional study was conducted among stroke patients in a tertiary hospital in Nantong City from January 2018 to December 2019. Lifestyle factors (smoking status, exercise), personal disease history (overweight, hypertension, dyslipidemia, diabetes mellitus, atrial fibrillation), family history of stroke, and demographic characteristics were interviewed by trained nurses. Inpatient costs and LOS were extracted from electronic medical records. Hierarchical multiple linear regression models and mediation analysis were used to examine the direct and indirect effects of the number of risk factors combined for stroke on inpatient costs. RESULTS A total of 620 individuals were included, comprising 391 ischaemic stroke patients and 229 haemorrhagic stroke patients, and the mean age was 63.2 years, with 60.32% being male. The overall mean cost for stroke inpatients was 30730.78 CNY ($ 4444.91), and the average length of stay (LOS) was 12.50 days. Mediation analysis indicated that the greater number of risk factors was not only directly related to higher inpatient costs (direct effect = 0.16, 95%CI:[0.11,0.22]), but also indirectly associated with inpatient cost through longer LOS (indirect effect = 0.08, 95% CI: [0.04,0.11]). Furthermore, patients with high risk of stroke had longer LOS than those in low-risk patients, which in turn led to heavier hospitalization expenses. CONCLUSIONS Both the greater number of risk factors and high-risk rating among stroke patients increased the length of stay and inpatient costs. Preventing and controlling risk behaviors of stroke should be strengthened.
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Affiliation(s)
- Xin Cao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Ruyu Li
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Weiwei Tang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu Province, 211166, China
| | - Wenjun Wang
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Jingya Ji
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Chengjie Yin
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Luyao Niu
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China
| | - Yuexia Gao
- Department of Health Management, School of Public Health, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
| | - Qiang Ma
- Institute for Health Development, Nantong University, Nantong, Jiangsu Province, 226019, China.
- Affiliated Hospital, Nantong University, Nantong, Jiangsu Province, 226019, China.
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Kim J, Grimley R, Kilkenny MF, Cadigan G, Johnston T, Andrew NE, Thrift AG, Lannin NA, Sundararajan V, Cadilhac DA. Costs of acute hospitalisation for stroke and transient ischaemic attack in Australia. HEALTH INF MANAG J 2023; 52:176-184. [PMID: 35667095 DOI: 10.1177/18333583221090277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stroke is a high-cost condition. Detailed patient-level assessments of the costs of care received and outcomes achieved provide useful information for organisation and optimisation of the health system. OBJECTIVES To describe the costs of hospital care for stroke and transient ischaemic attack (TIA) and investigate factors associated with costs. METHODS Retrospective cohort study using data from the Australian Stroke Clinical Registry (AuSCR) collected between 2009 and 2013 linked to hospital administrative data and clinical costing data in Queensland. Clinical costing data include standardised assignment of costs from hospitals that contribute to the National Hospital Costing programme. Patient-level costs for each hospital admission were described according to the demographic, clinical and treatment characteristics of patients. Multivariable median regression with clustering by hospital was used to determine factors associated with greater costs. RESULTS Among 22 hospitals, clinical costing data were available for 3909 of 5522 patient admissions in the AuSCR (71%). Compared to those without clinical costing data, patients with clinical costing data were more often aged <65 years (30% with cost data vs 24% without cost data, p < 0.001) and male (56% with cost data vs 49% without cost data, p < 0.001). Median cost of an acute episode was $7945 (interquartile range $4176 to $14970) and the median length of stay was 5 days (interquartile range 2 to 10 days). The most expensive cost buckets were related to medical (n = 3897, median cost $1577), nursing (n = 3908, median cost $2478) and critical care (n = 434, median cost $3064). Factors associated with greater total costs were a diagnosis of intracerebral haemorrhage, greater socioeconomic position, in-hospital stroke and prior history of stroke. CONCLUSION Medical and nursing costs were incurred by most patients admitted with stroke or TIA, and were relatively more expensive on average than other cost buckets such as imaging and allied health. IMPLICATIONS Scaling this data linkage to national data collections may provide valuable insights into activity-based funding at public hospitals. Regular report of these costs should be encouraged to optimise economic evaluations.
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Affiliation(s)
- Joosup Kim
- Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | | | - Monique F Kilkenny
- Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | | | | | | | | | - Natasha A Lannin
- Monash University, Clayton, VIC, Australia
- Alfred Health, Prahran, VIC, Australia
| | | | - Dominique A Cadilhac
- Monash University, Clayton, VIC, Australia
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Strilciuc S, Grad DA, Radu C, Chira D, Stan A, Ungureanu M, Gheorghe A, Muresanu FD. The economic burden of stroke: a systematic review of cost of illness studies. J Med Life 2021; 14:606-619. [PMID: 35027963 PMCID: PMC8742896 DOI: 10.25122/jml-2021-0361] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 01/02/2023] Open
Abstract
Stroke is one of the leading causes of morbidity and mortality worldwide. As the number of stroke cases is rising from one year to another, policymakers require data on the amount spent on stroke to enforce better financing policies for prevention, hospital care, outpatient rehabilitation services and social services. We aimed to systematically assess the economic burden of stroke at global level. Cost of stroke studies were retrieved from five databases. We retrieved the average cost per patient, where specified, or estimated it using a top-down approach. Resulting costs were grouped in two main categories: per patient per year and per patient lifetime. We extracted information from forty-six cost of illness studies. Per patient per year costs are larger in high income countries and in studies conducted from the payer perspective. The highest average per patient per year cost by country was reported in the United States ($59,900), followed by Sweden ($52,725) and Spain ($41,950). The highest per patient lifetime costs were reported in Australia ($232,100) for all identified definitions of stroke. Existing literature regarding the economic burden of stroke is concentrated in high-income settings, with very few studies conducted in South America and Africa. Published manuscripts on this topic highlight substantial methodological heterogeneity, rendering comparisons difficult or impossible, even within the same country or among studies with similar costing perspectives.
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Affiliation(s)
- Stefan Strilciuc
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Constantin Radu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Diana Chira
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Adina Stan
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Marius Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Adrian Gheorghe
- Department of Infectious Disease Epidemiology, Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Fior-Dafin Muresanu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Strilciuc S, Grad DA, Mixich V, Stan A, Buzoianu AD, Vladescu C, Vintan MA. Societal Cost of Ischemic Stroke in Romania: Results from a Retrospective County-Level Study. Brain Sci 2021; 11:brainsci11060689. [PMID: 34073732 PMCID: PMC8225161 DOI: 10.3390/brainsci11060689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). METHODS The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. RESULTS The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). CONCLUSIONS Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.
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Affiliation(s)
- Stefan Strilciuc
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 4000012 Cluj-Napoca, Cluj, Romania; (A.S.); (M.A.V.)
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400354 Cluj-Napoca, Cluj, Romania;
- Department of Public Health, Babes-Bolyai University, No. 7 Pandurilor Street, 400376 Cluj-Napoca, Cluj, Romania;
- Correspondence:
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400354 Cluj-Napoca, Cluj, Romania;
- Department of Public Health, Babes-Bolyai University, No. 7 Pandurilor Street, 400376 Cluj-Napoca, Cluj, Romania;
| | - Vlad Mixich
- Department of Public Health, Babes-Bolyai University, No. 7 Pandurilor Street, 400376 Cluj-Napoca, Cluj, Romania;
| | - Adina Stan
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 4000012 Cluj-Napoca, Cluj, Romania; (A.S.); (M.A.V.)
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400354 Cluj-Napoca, Cluj, Romania;
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Cluj, Romania;
| | - Cristian Vladescu
- National School of Public Health Management and Professional Development, No 31 Vaselor, Street, 030167 Bucharest, Romania;
- Department of Public Health, University of Medicine and Pharmacy Victor Babes, No.2 Eftimie Murgu Square, 300041 Timisoara, Timis, Romania
| | - Mihaela Adela Vintan
- Department of Neurosciences, “Iuliu Hatieganu” University of Medicine and Pharmacy, 4000012 Cluj-Napoca, Cluj, Romania; (A.S.); (M.A.V.)
- RoNeuro Institute for Neurological Research and Diagnostic, No. 37 Mircea Eliade Street, 400354 Cluj-Napoca, Cluj, Romania;
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Abstract
Hemorrhagic stroke comprises about 20% of all strokes, with intracerebral hemorrhage (ICH) being the most common type. Frequency of ICH is increased where hypertension is untreated. ICH in particularly has a disproportionately high risk of early mortality and long-term disability. Until recently, there has been a paucity of randomized controlled trials (RCTs) to provide evidence for the efficacy of various commonly considered interventions in ICH, including acute blood pressure management, coagulopathy reversal, and surgical hematoma evacuation. Evidence-based guidelines do exist for ICH and these form the basis for a framework of care. Current approaches emphasize control of extremely high blood pressure in the acute phase, rapid reversal of vitamin K antagonists, and surgical evacuation of cerebellar hemorrhage. Lingering questions, many of which are the topic of ongoing clinical research, include optimizing individual blood pressure targets, reversal strategies for newer anticoagulant medications, and the role of minimally invasive surgery. Risk stratification models exist, which derive from findings on clinical exam and neuroimaging, but care should be taken to avoid a self-fulfilling prophecy of poor outcome from limiting treatment due to a presumed poor prognosis. Cerebral venous thrombosis is an additional subtype of hemorrhagic stroke that has a unique set of causes, natural history, and treatment and is discussed as well.
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Affiliation(s)
- Arturo Montaño
- Departments of Neurology and Neurosurgery, University of Colorado, Aurora, CO, United States
| | - Daniel F Hanley
- Departments of Neurology and Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - J Claude Hemphill
- Departments of Neurology and Neurosurgery, University of California San Francisco, San Francisco, CA, United States.
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Puumalainen A, Elonheimo O, Brommels M. Costs structure of the inpatient ischemic stroke treatment using an exact costing method. Heliyon 2020; 6:e04264. [PMID: 32613126 PMCID: PMC7322047 DOI: 10.1016/j.heliyon.2020.e04264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/19/2019] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Most stroke care expenses are inhospital costs. Given the previously reported inaccuracy of conventional costing, the purpose of this study was to provide an accurate analysis of inpatient costs of stroke care in an acute care hospital. Materials and methods We used activity-based costing (ABC) for calculating the costs of ischemic stroke patients. We collected the activity data at the Helsinki University Central Hospital. Persons involved in patient care logged their activities on survey forms for one week. The costs of activities were calculated based on information about salaries, material prices, and other costs obtained from hospital accounting data. We calculated costs per inpatient days and episodes, analyzed cost structure, made a distinction in cost for stroke subtypes according to the Oxford and TOAST classification schemes, and compared cost per inpatient episode with the diagnoses-related group (DRG) -price of the hospital. Results The sample comprised 196 inpatient days of 41 patients. By using the ABC, the mean and median costs of an inpatient day were 346 € and 268 €, and of an inpatient episode 3322 € and 2573 €, respectively. Average costs differed considerably by stroke subtype. The first inpatient day was the most expensive. Working time costs comprised 63% of the average inpatient day cost, with nursing constituting the largest proportion. The mean cost of an inpatient episode was 21% lower with ABC than with DRG pricing. Conclusion We demonstrate that there are differences in cost estimates depending on the methods used. ABC revealed differences among patients having the same diagnosis. The cost of an episode was lower than the DRG price of the hospital. Choosing an optimal costing method is essential for both reimbursements of hospitals and health policy decision-making.
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Affiliation(s)
- Anne Puumalainen
- Department of Public Health, University of Helsinki, Kajavankatu 2C 79, 04230, Kerava, Finland
- Corresponding author.
| | - Outi Elonheimo
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Nascimento LR, Scianni AA, Ada L, Fantauzzi MO, Hirochi TL, Teixeira-Salmela LF. Predictors of return to work after stroke: a prospective, observational cohort study with 6 months follow-up. Disabil Rehabil 2019; 43:525-529. [PMID: 31242399 DOI: 10.1080/09638288.2019.1631396] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine, in Brazil, the proportion of individuals who return to a paid work after stroke, and the factors which predict this. MATERIALS AND METHODS A prospective observational cohort study was carried out for six months. Participants were recruited early after stroke from four public hospitals. The outcome of interest was return to work, and the following predictors were investigated: age, sex, education, marital status, contribution to household income, type of work, independence, and depression. Logistic regression was used to identify multivariate predictors of return to work. RESULTS Of the 117 included participants, 52 (44%) had returned to work by 6 months. Contribution to household income (OR 2.4; 95% CI 1.0 to 5.9), being a white-collar worker (OR 4.0; 95% CI 1.8 to 8.6) and being independent in daily activities at 3 months (OR 10.6; 95% CI 2.9 to 38.3), in combination, positively predicted return to work. CONCLUSIONS Less than 50% of stroke survivors returned to work six months after stroke. Among predictors, only the level of dependence in daily activities is a modifiable factor. Interventions aimed at reducing disability after stroke might increase rates of return to work.Implications for rehabilitationIn Brazil, less than 50% of stroke survivors returned to work six months after stroke.Clinicians may collect information regarding household income, type of work and dependence in daily activities to estimate chances of returning to work, in developing countries.Being independent at 3 months was the strongest predictor of return to work; therefore, interventions aimed at reducing disability after stroke may increase rates of return to work.
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Affiliation(s)
- Lucas R Nascimento
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Center of Health Sciences, Universidade Federal do Espírito Santo, Vitória, Brazil
| | - Aline A Scianni
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Louise Ada
- Discipline of Physiotherapy, The University of Sydney, Sydney, Australia
| | - Marcela O Fantauzzi
- Department of Physiotherapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Tânia L Hirochi
- Department of Occupational Therapy, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U. Economic burden of stroke: a systematic review on post-stroke care. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:107-134. [PMID: 29909569 DOI: 10.1007/s10198-018-0984-0] [Citation(s) in RCA: 261] [Impact Index Per Article: 52.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/03/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. METHODS A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. RESULTS We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. CONCLUSION The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.
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Affiliation(s)
- S Rajsic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - H Gothe
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Health Sciences/Public Health, Dresden Medical School "Carl Gustav Carus", Technical University Dresden, Dresden, Germany
| | - H H Borba
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
| | - G Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - J Vujicic
- Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - T Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard Chan School of Public Health, Boston, MA, USA.
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Pike J, Grosse SD. Friction Cost Estimates of Productivity Costs in Cost-of-Illness Studies in Comparison with Human Capital Estimates: A Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2018; 16:765-778. [PMID: 30094591 PMCID: PMC6467569 DOI: 10.1007/s40258-018-0416-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Cost-of-illness (COI) studies often include the 'indirect' cost of lost production resulting from disease, disability, and premature death, which is an important component of the economic burden of chronic conditions assessed from the societal perspective. In most COI studies, productivity costs are estimated primarily as the economic value of production forgone associated with loss of paid employment (foregone gross earnings); some studies include the imputed value of lost unpaid work as well. This approach is commonly but imprecisely referred to as the human capital approach (HCA). However, there is a lack of consensus among health economists as to how to quantify loss of economic productivity. Some experts argue that the HCA overstates productivity losses and propose use of the friction cost approach (FCA) that estimates societal productivity loss as the short-term costs incurred by employers in replacing a lost worker. This review sought to identify COI studies published during 1995-2017 that used the FCA, with or without comparison to the HCA, and to compare FCA and HCA estimates from those studies that used both approaches. We identified 80 full COI studies (of which 75% focused on chronic conditions), roughly 5-8% of all COI studies. The majority of those studies came from three countries, Canada, Germany, and the Netherlands, that have officially endorsed use of the FCA. The FCA results in smaller productivity loss estimates than the HCA, although the differential varied widely across studies. Lack of standardization of HCA and FCA methods makes productivity cost estimates difficult to compare across studies.
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Affiliation(s)
- Jamison Pike
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases, 1600 Clifton Road NE, MS A-19, Atlanta, GA, 30329-4027, USA.
| | - Scott D Grosse
- Centers for Disease Control and Prevention, National Center on Birth Defects and Developmental Disabilities, Atlanta, GA, USA
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Zhao Y, Guthridge S, Falhammar H, Flavell H, Cadilhac DA. Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: an observational cohort study in the Northern Territory of Australia. BMJ Open 2017; 7:e015033. [PMID: 28982808 PMCID: PMC5640075 DOI: 10.1136/bmjopen-2016-015033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. DESIGN Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. SETTING Public hospitals in the NT from 1992 to 2013. PARTICIPANTS Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. RESULTS 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). CONCLUSIONS Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Howard Flavell
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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Carey S, Wrogemann J, Booth FA, Rafay MF. Epidemiology, Clinical Presentation, and Prognosis of Posterior Circulation Ischemic Stroke in Children. Pediatr Neurol 2017; 74:41-50. [PMID: 28676245 DOI: 10.1016/j.pediatrneurol.2017.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/11/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Anterior and posterior circulation strokes are often different in terms of presentation and recurrence risk, but there are few studies that focused on posterior circulation stroke. METHODS We performed a longitudinal retrospective study of children, birth to 18 years, with posterior circulation ischemic stroke at the Children's Hospital Winnipeg from January 1992 to December 2012. Clinical and radiological features and outcomes were collected using standardized tools. RESULTS Of the 158 children with arterial ischemic stroke, 23 (14.5%) children, 21 non-neonates, and 11 males were identified. For posterior circulation ischemic stroke, mean crude incidence of 0.38 and crude mortality rate of 0.11 per 100,000 person-years was estimated. The crude total period prevalence rate for the study period was estimated as 8.1 per 100,000 children. Nonspecific symptoms before stroke presentation were present in 38% and impaired consciousness in 71%. Identifiable risk factors were present in two thirds: vasculopathy 24%, infection 19%, trauma 14%, and congenital heart disease 9.5%. Average Pediatric National Institutes of Health Stroke Scale score at presentation was 11. Poor outcome was noted in 45%. Outcome did not change significantly between 12 and 24 months. Aboriginal ethnicity (P = 0.01), high Pediatric National Institutes of Health Stroke Scale score (P = 0.001), bilateral infarction (P = 0.001), and large caliber artery territory infarction (P = 0.02) predicted poor outcome. CONCLUSIONS Our hospital-based incidence and outcome data provide valuable information to help direct treatment strategies and prognosticate children with posterior circulation ischemic stroke. Our study calls for close observation and early management of children with posterior circulation stroke, in particular with aboriginal ancestry and bilateral and large artery territory infarction.
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Affiliation(s)
| | - Jens Wrogemann
- Section of Pediatric Radiology, Department of Radiology, Manitoba, Canada
| | - Frances A Booth
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada
| | - Mubeen F Rafay
- Section of Pediatric Neurology, Department of Pediatrics and Child Health, University of Manitoba, Manitoba, Canada; Dr. M. Rafay Medical Corporation, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
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Determinants of Length of Stay Following Total Anterior Circulatory Stroke. Geriatrics (Basel) 2017; 2:geriatrics2030026. [PMID: 31011036 PMCID: PMC6371159 DOI: 10.3390/geriatrics2030026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/25/2017] [Accepted: 07/29/2017] [Indexed: 01/09/2023] Open
Abstract
Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The study sample population was drawn from the Norfolk and Norwich Stroke and Transient Ischemic Attack (TIA) Register (1996–2012), a prospective registry. 2965 patients admitted with TACS verified by a stroke specialist team were included. Primary analysis identified predictors of length of stay (LOS) in either haemorrhagic or ischaemic TACS. Secondary analyses identified predictors of LOS in patients who were discharged alive or who died during admission separately. Moderate (p = 0.014) to severe disability (p = 0.015) and history of congestive heart failure (p = 0.027) in the primary analysis and pre-stroke residence in a care facility among patients who survived to discharge (p = 0.013) were associated with a shorter length of stay. Factors associated with increased length of stay included presence of neurological lateralisation in the primary analysis (p = 0.004) and amongst patients who died (p = 0.003 and p = 0.014 for ischaemic and haemorrhagic stroke, respectively). Patients with advanced age (≥85 years) with haemorrhagic stroke had longer LOS regardless of mortality outcome. Patients with low pre-morbid disability (modified Rankin score ≤2 who died following haemorrhagic TACS also had longer LOS. Our study found predictors of LOS following TACS include neurological lateralisation, pre-stroke disability status, congestive heart failure, pre-morbid residence and age. The identification of such factors would assist in resource allocation and discharge planning.
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Abstract
Objectives This study aims to estimate the annual economic cost per hemiplegic patient in Turkey. Patients and methods Between September 2014 and December 2014, a total of 84 hemiplegic patients (53 males, 31 females; mean age 61.4±13.5 years; range 28-89 years) with stroke for 12 months were included in the study. Type of cerebrovascular accident and complications were evaluated. Hospital records and data from the relatives of the patients were used to calculate the cost. Annual costs were evaluated starting from first hospitalization. Direct costs were calculated with the sum of hospital care (acute care, diagnostic investigations, treatment and rehabilitation), medications, medical visits, outpatient rehabilitation and orthopedic aids. Indirect costs were calculated by taking the income loss due to absence from work into consideration. Prices of medical resources were obtained from the 2014 Healthcare Implementation Notification payment list. Results At the end of the study, the average direct cost and indirect cost per patient were calculated respectively as 10,594.90±6,554.20 Turkish liras and 9,357.10±10,195.60 Turkish liras (4,606.47±2,849.65 USD and 4,068.30±4,432.86 USD). We found a negative correlation between total cost and age (p=0.001), and a positive correlation with duration of hospitalization (p=0.001) and number of complications (p=0.049). We were unable to find any relation of cost with sex and cerebrovascular accident type. Spasticity (p=0.028) and epilepsy (p=0.037) being among the complications were observed to increase the cost. Conclusion Stroke is an important economic burden for Turkish population. Preventive social measures are necessary to reduce this cost.
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Abstract
Background: Neuropsychological deficits occur in over half of the stroke survivors and are associated with the reduced functioning and a decline in quality of life. However, the trajectory of recovery and predictors of neuropsychological outcomes over the first year post stroke are poorly understood.Method: Neuropsychological performance, assessed using the CNS-Vital signs, was examined at 1 month, 6 months and 12 months after ischaemic stroke (IS) in a sample drawn from a population-based study (N = 198).Results: While mean scores across neuropsychological domains at each time-point fell in the average range, one in five individuals produced very low-range scores for verbal memory, attention and psychomotor speed. Significant improvements were seen for executive functioning, psychomotor speed and cognitive flexibility within 6 months post stroke, but no gains were noted from 6 to 12 months. Stroke-related neurological deficits and depression at baseline significantly contributed to the prediction of neuropsychological function at 12 month follow-up.Conclusions: In a significant minority of IS survivors, focal deficits are evident in psychomotor speed, verbal memory, executive functions and attention. Significant improvements in these domains were only evident in the first 6 months post stroke. Initial stroke-related neurological deficits and concurrent depression may be the best predictors of later cognitive functioning.
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Wood AD, Gollop ND, Bettencourt-Silva JH, Clark AB, Metcalf AK, Bowles KM, Flather MD, Potter JF, Myint PK. A 6-Point TACS Score Predicts In-Hospital Mortality Following Total Anterior Circulation Stroke. J Clin Neurol 2016; 12:407-413. [PMID: 27819414 PMCID: PMC5063865 DOI: 10.3988/jcn.2016.12.4.407] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 01/26/2016] [Accepted: 01/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background and Purpose Little is known about the factors associated with in-hospital mortality following total anterior circulation stroke (TACS). We examined the characteristics and comorbidity data for TACS patients in relation to in-hospital mortality with the aim of developing a simple clinical rule for predicting the acute mortality outcome in TACS. Methods A routine data registry of one regional hospital in the UK was analyzed. The subjects were 2,971 stroke patients with TACS (82% ischemic; median age=81 years, interquartile age range=74–86 years) admitted between 1996 and 2012. Uni- and multivariate regression models were used to estimate in-hospital mortality odds ratios for the study covariates. A 6-point TACS scoring system was developed from regression analyses to predict in-hospital mortality as the outcome. Results Factors associated with in-hospital mortality of TACS were male sex [adjusted odds ratio (AOR)=1.19], age (AOR=4.96 for ≥85 years vs. <65 years), hemorrhagic subtype (AOR=1.70), nonlateralization (AOR=1.75), prestroke disability (AOR=1.73 for moderate disability vs. no symptoms), and congestive heart failure (CHF) (AOR=1.61). Risk stratification using the 6-point TACS Score [T=type (hemorrhage=1 point) and territory (nonlateralization=1 point), A=age (65–84 years=1 point, ≥85 years=2 points), C=CHF (if present=1 point), S=status before stroke (prestroke modified Rankin Scale score of 4 or 5=1 point)] reliably predicted a mortality outcome: score=0, 29.4% mortality; score=1, 46.2% mortality [negative predictive value (NPV)=70.6%, positive predictive value (PPV)=46.2%]; score=2, 64.1% mortality (NPV=70.6, PPV=64.1%); score=3, 73.7% mortality (NPV=70.6%, PPV=73.7%); and score=4 or 5, 81.2% mortality (NPV=70.6%, PPV=81.2%). Conclusions We have identified the key determinants of in-hospital mortality following TACS and derived a 6-point TACS Score that can be used to predict the prognosis of particular patients.
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Affiliation(s)
- Adrian D Wood
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Joao H Bettencourt-Silva
- Norfolk and Norwich University Hospital, Norwich, UK.,Clinical Informatics, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Allan B Clark
- Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | | | - Kristian M Bowles
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Marcus D Flather
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - John F Potter
- Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Phyo Kyaw Myint
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Norwich Cardiovascular Research Group, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK.
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The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol 2015; 30:251-77. [DOI: 10.1007/s10654-014-9984-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022]
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The global impact of non-communicable diseases on households and impoverishment: a systematic review. Eur J Epidemiol 2014; 30:163-88. [PMID: 25527371 DOI: 10.1007/s10654-014-9983-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022]
Abstract
The global economic impact of non-communicable diseases (NCDs) on household expenditures and poverty indicators remains less well understood. To conduct a systematic review and meta-analysis of the literature evaluating the global economic impact of six NCDs [including coronary heart disease, stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on households and impoverishment. Medline, Embase and Google Scholar databases were searched from inception to November 6th 2014. To identify additional publications, reference lists of retrieved studies were searched. Randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults and assessing the economic consequences of NCDs on households and impoverishment. No language restrictions. All abstract and full text selection was done by two independent reviewers. Data were extracted by two independent reviewers and checked by a third independent reviewer. Studies were included evaluating the impact of at least one of the selected NCDs and on at least one of the following measures: expenditure on medication, transport, co-morbidities, out-of-pocket (OOP) payments or other indirect costs; impoverishment, poverty line and catastrophic spending; household or individual financial cost. From 3,241 references, 64 studies met the inclusion criteria, 75% of which originated from the Americas and Western Pacific WHO region. Breast cancer and DM were the most studied NCDs (42 in total); CKD and COPD were the least represented (five and three studies respectively). OOP payments and financial catastrophe, mostly defined as OOP exceeding a certain proportion of household income, were the most studied outcomes. OOP expenditure as a proportion of family income, ranged between 2 and 158% across the different NCDs and countries. Financial catastrophe due to the selected NCDs was seen in all countries and at all income levels, and occurred in 6-84% of the households depending on the chosen catastrophe threshold. In 16 low- and middle-income countries (LMIC), 6-11% of the total population would be impoverished at a 1.25 US dollar/day poverty line if they would have to purchase lowest price generic diabetes medication. NCDs impose a large and growing global impact on households and impoverishment, in all continents and levels of income. The true extent, however, remains difficult to determine due to the heterogeneity across existing studies in terms of populations studied, outcomes reported and measures employed. The impact that NCDs exert on households and impoverishment is likely to be underestimated since important economic domains, such as coping strategies and the inclusion of marginalized and vulnerable people who do not seek health care due to financial reasons, are overlooked in literature. Given the scarcity of information on specific regions, further research to estimate impact of NCDs on households and impoverishment in LMIC, especially the Middle Eastern, African and Latin American regions is required.
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Abstract
Background:Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs.Methodology:The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): non-disabling stroke (mRS 0-2) and disabling stroke (mRS 3-5).Results:We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes.Conclusions:An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A “back of the envelope” calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.
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Gloede TD, Halbach SM, Thrift AG, Dewey HM, Pfaff H, Cadilhac DA. Long-Term Costs of Stroke Using 10-Year Longitudinal Data From the North East Melbourne Stroke Incidence Study. Stroke 2014; 45:3389-94. [DOI: 10.1161/strokeaha.114.006200] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke is costly, although little is known about the long-term costs of survivors of stroke. In previous cost-of-illness studies, lifetime costs have been modeled based on estimates to 5 years after stroke. Building on previous work from the North East Melbourne Stroke Incidence Study (NEMESIS), we aimed to describe resource use at 10 years and recalculate the lifetime societal costs of ischemic and hemorrhagic (intracerebral hemorrhage) stroke.
Methods—
Ten-year patient-level resource use data were obtained and updated prices and population demographic statistics for 2010 were applied to our cost-of-illness models. We incorporated incidence data from a larger study region of NEMESIS than that used in the previous model and new 10-year survival and recurrent stroke rates. One-way sensitivity and probabilistic multivariable uncertainty analyses were undertaken.
Results—
For ischemic stroke, the overall average annual direct costs at 10 years (US dollars [USD] 5207) were comparable to those for survivors between 3 and 5 years (USD5438). However, the contribution of some costs varied (eg, medications contributed 13% at 5 years and 20% at 10 years). For intracerebral hemorrhage, annual direct costs were considerably (24%) greater at 10 years than estimated using 3 to 5 year data. Greater average lifetime costs per case were found using the updated models (ischemic stroke: previous model USD51806 and current USD68 769; intracerebral hemorrhage: previous model USD43 786 and current USD54 956 per case). Following sensitivity and multivariable uncertainty analyses, the findings were robust.
Conclusions—
Costs to 10 years after stroke have not previously been reported. Our findings demonstrate the importance of estimating resource use over longer periods for forecasting lifetime estimates.
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Affiliation(s)
- Tristan D. Gloede
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Sarah M. Halbach
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Amanda G. Thrift
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Helen M. Dewey
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Holger Pfaff
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
| | - Dominique A. Cadilhac
- From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A
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Kam JK, Chen Z, Liew D, Yan B. Does warfarin-related intracerebral haemorrhage lead to higher costs of management? Clin Neurol Neurosurg 2014; 126:38-42. [PMID: 25201813 DOI: 10.1016/j.clineuro.2014.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/10/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND PURPOSE Warfarin-related intracerebral haemorrhage is associated with significant morbidity but long term treatment costs are unknown. Our study aimed to assess the cost of warfarin-related intracerebral haemorrhage. METHODS We included all patients with intracerebral haemorrhage between July 2006 and December 2011 at a single centre. We collected data on anticoagulant use, baseline clinical variables, discharge destinations, modified Rankin Scale at discharge and in-hospital costings. First year costings were extracted from previous studies. Multiple linear regression for treatment cost was performed with stratified analysis to assess for effect modification. RESULTS There were 694 intracerebral haemorrhage patients, with 108 (15.6%) previously on warfarin. Mean age (SD) of participants was 70.3 (13.6) and 58.5% were male. Patients on warfarin compared to those not on warfarin had significantly lower rates of discharge home (12.0% versus 18.9%, p=0.013). Overall total costs between groups were similar, $AUD 25,767 for warfarin-related intracerebral haemorrhage and $AUD 27,388 for non-warfarin intracerebral haemorrhage (p=0.353). Stratified analysis showed survivors of warfarin-related intracerebral haemorrhage had higher costs compared to those without warfarin ($AUD 33,419 versus $AUD 30,193, p<0.001) as well as increased length of stay (12 days versus 8 days, p<0.001). Inpatient mortality of patients on warfarin was associated with a shorter length of stay (p=0.001) and lower costs. CONCLUSION Survival of initial haemorrhage on warfarin was associated with increased treatment cost and length of stay but this was discounted by higher rates and earlier nature of mortality in warfarinised patients.
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Affiliation(s)
- Jeremy K Kam
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Zhibin Chen
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Danny Liew
- Department of Medicine, University of Melbourne, Melbourne, Australia; Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia
| | - Bernard Yan
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia.
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Bray JE, Coughlan K, Mosley I, Barger B, Bladin C. Are suspected stroke patients identified by paramedics transported to appropriate stroke centres in Victoria, Australia? Intern Med J 2014; 44:515-8. [DOI: 10.1111/imj.12382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 09/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J. E. Bray
- Research and Evaluation Department; Ambulance Victoria; Melbourne Victoria Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
| | - K. Coughlan
- Department of Neuroscience; Box Hill Hospital; Melbourne Victoria Australia
| | - I. Mosley
- Division of Stroke Epidemiology and Public Health; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
| | - B. Barger
- Research and Evaluation Department; Ambulance Victoria; Melbourne Victoria Australia
| | - C. Bladin
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Victoria Australia
- Department of Neuroscience; Box Hill Hospital; Melbourne Victoria Australia
- Division of Stroke Epidemiology and Public Health; Florey Institute of Neuroscience and Mental Health; Melbourne Victoria Australia
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Liu B, Liu LZ, Xuan J, Luo M, Li Y, Duan C, Cheng H, Yang X. Treatment patterns associated with stroke prevention in patients with atrial fibrillation in three major cities in the People's Republic of china. Int J Gen Med 2014; 7:29-35. [PMID: 24379692 PMCID: PMC3872083 DOI: 10.2147/ijgm.s49477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with an increased risk of stroke. This study assessed treatment patterns associated with stroke prevention among patients with AF in three major cities of the People's Republic of China. METHODS A random sample of 2,862 medical charts for patients with AF at six tertiary hospitals located in Beijing, Shanghai, and Guangzhou between 2003 and 2008 were reviewed. Patient demographics, clinical characteristics, and treatment patterns were extracted from medical charts. Antithrombotic regimens included antiplatelets, anticoagulants, and a combination of both. Descriptive analyses were performed to summarize basic antithrombotic patterns. A logistic regression model examined demographic and clinical factors associated with antithrombotic treatment patterns. RESULTS Of the patient sample, 55% were male, the average age was 72 years (49% ≥75 years), 15% had valvular AF, 78% had nonvalvular AF, and the remainder had unspecified AF. CHADS2 scores ≥2 were reported for 53% of patients. Antithrombotic treatment was not received by 17% of patients during hospitalization, and 66% did not receive warfarin. Among patients with valvular or nonvalvular AF, 33%, 30%, and 20% received antiplatelet, anticoagulation, and antiplatelet plus anticoagulation treatments, respectively. For patients with CHADS2 scores of 0, 1, 2, 3, and ≥4, 52%, 42%, 28%, 21%, and 21%, respectively, were treated with warfarin. Predictors of no antithrombotic treatment included age and hospital location. CONCLUSION Anticoagulation therapy was underused in Chinese patients with AF. Antithrombotic treatment was not associated with stroke risk. Further studies need to examine the clinical consequences of various antithrombotic treatment patterns in Chinese patients with AF.
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Affiliation(s)
- Bao Liu
- School of Public Health, Fudan University, shanghai, People's Republic of China
| | - Larry Z Liu
- Pfizer Inc, New York, NY, USA ; Weill Medical college of cornell University, new York, NY, USA
| | | | - Man Luo
- Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yansheng Li
- Renji Hospital Shanghai Jiaotong University, Shanghai, People's Republic of China
| | - Chaohui Duan
- The Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hongqin Cheng
- Xuanwu Hospital, Beijing, People's Republic of China
| | - Xiaohui Yang
- Beijing Anzhen Hospital, Capital University of Medical Science, Beijing, People's Republic of China
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Gnonlonfoun DD, Adoukonou T, Adjien C, Nkouei E, Houinato D, Avode DG, Preux PM. Factors associated with stroke direct cost in francophone West Africa, Benin example. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjns.2013.34039] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Long-Term Costs of Ischemic Stroke and Major Bleeding Events among Medicare Patients with Nonvalvular Atrial Fibrillation. Cardiol Res Pract 2012; 2012:645469. [PMID: 23082276 PMCID: PMC3467774 DOI: 10.1155/2012/645469] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose. Acute healthcare utilization of stroke and bleeding has been previously examined among patients with nonvalvular atrial fibrillation (NVAF). The long-term cost of such outcomes over several years is not well understood. Methods. Using 1999–2009 Medicare medical and enrollment data, we identified incident NVAF patients without history of stroke or bleeding. Patients were followed from the first occurrence of ischemic stroke, major bleeding, or intracranial hemorrhage (ICH) resulting in hospitalization. Those with events were matched with 1–5 NVAF patients without events. Total incremental costs of events were calculated as the difference between costs for patients with events and matched controls for up to 3 years. Results. Among the 25,465 patients who experienced events, 94.5% were successfully matched. In the first year after event, average incremental costs were $32,900 for ischemic stroke, $23,414 for major bleeding, and $47,640 for ICH. At 3 years after these events, costs remained elevated by $3,156–$5,400 per annum. Conclusion. While the costs of stroke and bleeding among patients with NVAF are most dramatic in the first year, utilization remained elevated at 3 years. Cost consequences extend beyond the initial year after these events and should be accounted for when assessing the cost-effectiveness of treatment regimens for stroke prevention.
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Casado A, Secades JJ, Ibarz R, Herdman M, Brosa M. Cost-effectiveness of citicoline versus conventional treatment in acute ischemic stroke. Expert Rev Pharmacoecon Outcomes Res 2012; 8:151-7. [PMID: 20528404 DOI: 10.1586/14737167.8.2.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
In the framework of an integral assessment (effectiveness and cost) of the use of neuroprotection in stroke, a cost-effectiveness study was conducted to compare the potential advantages of citicoline with conventional therapy (without neuroprotection or placebo) in patients with acute ischemic stroke. The literature was searched for systematic reviews and meta-analyses evaluating the effectiveness of citicoline versus placebo in the hospital setting and during 12 weeks after discharge from hospital. Data on the use of resources were obtained from a panel of experts of four acute-care teaching hospitals in Spain. The study was performed from the perspective of the Spanish National Health System. Two meta-analyses were included (Cochrane Stroke Review Group and a pooling analysis). Treatment with citicoline resulted in 99 or 50 more patients recovered per 1000 patients treated (depending on selection criteria of the Cochrane study and the pooled analysis), with average cost savings between euro101.2 and euro126.4 per patient treated of the type of those included in the Cochrane study. In patients with acute ischemic stroke, treatment with placebo was more expensive and less effective in the scenarios of inpatient care and inpatient plus outpatient care after discharge from the hospital.
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Zhao YJ, Tan LCS, Au WL, Heng DMK, Soh IAL, Li SC, Luo N, Wee HL. Estimating the lifetime economic burden of Parkinson's disease in Singapore. Eur J Neurol 2012; 20:368-74. [PMID: 22978629 DOI: 10.1111/j.1468-1331.2012.03868.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 08/07/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to estimate the lifetime cost of Parkinson's disease (PD) from the societal perspective. METHODS A convenience sample of English or Chinese-speaking patients with PD was recruited from a PD and Movement Disorders Centre in Singapore to complete a financial burden questionnaire. Sociodemographic and clinical data were retrieved from hospital databases. Markov cohort model analysis was performed (cycle length, 1-year; duration, death or reached 100 years old). Patients were assumed to progress from one Markov state to the next state or death without skipping states or regressing. All model parameters were based on published local data. RESULTS In 195 patients with PD (median age: 68.9, male: 51.8%), the simulated lifetime cost of PD was Singapore Dollar (SGD) 60,487 (EUR purchasing power parity 56,253) per patient. Direct medical, non-medical and indirect cost accounted for 18.8%, 12.8% and 68.4% of total lifetime cost, respectively. The top three components of total lifetime cost were productivity losses (67.6%), pharmacotherapy (11.4%) and home care (8.7%). One-way sensitivity analysis and probabilistic sensitivity analyses revealed that estimates were sensitive to cost at H&Y stage 1, 2 and 2.5 and productivity losses. CONCLUSIONS The lifetime cost of PD is evaluated for the first time. This cost is substantial and comparable to the lifetime cost of intracerebral haemorrhage in at least one study. Our study identified several priority areas for research and policy formulation: reducing productivity losses, reducing cost of pharmacotherapy, avoiding hospitalization and reducing home care cost.
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Affiliation(s)
- Y J Zhao
- Department of Pharmacy, National University of Singapore, Republic of Singapore
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Maharaj JC, Reddy M. Young stroke mortality in fiji islands: an economic analysis of national human capital resource loss. ISRN NEUROLOGY 2012; 2012:802785. [PMID: 22778993 PMCID: PMC3388426 DOI: 10.5402/2012/802785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/02/2012] [Indexed: 11/23/2022]
Abstract
Introduction. The objective of this study was to perform an economic analysis in terms of annual national human capital resource loss from young stroke mortality in Fiji. The official retirement age is 55 years in Fiji. Method. Stroke mortality data, for working-age group 15-55 years, obtained from the Ministry of Health and per capita national income figure for the same year was utilised to calculate the total output loss for the economy. The formula of output loss from the economy was used. Results. There were 273 stroke deaths of which 53.8% were of working-age group. The annual national human capital loss from stroke mortality for Fiji for the year was calculated to be F$8.85 million (US$5.31 million). The highest percentage loss from stroke mortality was from persons in their forties; that is, they still had more then 10 years to retirement. Discussion. This loss equates to one percent of national government revenue and 9.7% of Ministry of Health budget for the same year. The annual national human capital loss from stroke mortality is an important dimension in the overall economic equation of total economic burden of stroke. Conclusion. This study demonstrates a high economic burden for Fiji from stroke mortality of young adults in terms of annual national human capital loss.
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Affiliation(s)
- Jagdish C Maharaj
- Lourdes Hospital and Community Health Service, P.O. Box 974, Dubbo, NSW 2830, Australia
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Rha JH, Koo J, Cho KH, Kim EG, Oh GS, Lee SJ, Cha JK, Oh JJ, Ham GR, Seo HS, Kim JS. Two-year direct medical costs of stroke in Korea: a multi-centre incidence-based study from hospital perspectives. Int J Stroke 2012; 8:186-92. [PMID: 22568522 DOI: 10.1111/j.1747-4949.2012.00815.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite increasing socio-economic burden of stroke, few studies have investigated the costs associated with the stroke care in Korea. We estimated the two-year direct medical costs associated with stroke. METHODS This was a multi-centre, incidence-based, retrospective observational study. We examined the records of all adult patients who were admitted in eight large hospitals throughout Korea due to acute stroke [I60: sub-arachnoid haemorrhage; I61: intracerebral haemorrhage; I62: other nontraumatic haemorrhage; I63: cerebral infarction, by The International Statistical Classification of Diseases and Related Health Problems (ICD)-10] between 1 November and 31 December 2006. Direct medical inpatient and outpatient cost of each patient was extracted from the medical record and the reimbursement claim data of the hospital. RESULTS Out of 908 studied patients (14% diagnosed as I60, 18% as I61, 3% as I62, and 65% as I63), 460 (50.7%) were assessed for more than one-year. The annual average direct medical costs were Korean 8,114,471 US$8732) for the first year, and Korean 431,527 for the second year. The first year costs for haemorrhagic stroke (I60-I62) (Korean 13,090,179) were significantly higher than those associated with cerebral infarction (I63) (Korean 5,460,459), whereas the second year costs were not different. Factors independently associated with high cost were female gender, young age, and first stroke. CONCLUSIONS Direct medical costs for stroke in Korea were determined, which seem to be lower than those of other developed countries. Female gender, young age, and first stroke were factors related to higher stroke cost.
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Te Ao BJ, Brown PM, Feigin VL, Anderson CS. Are stroke units cost effective? Evidence from a New Zealand stroke incidence and population-based study. Int J Stroke 2011; 7:623-30. [PMID: 22010968 DOI: 10.1111/j.1747-4949.2011.00632.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Acute stroke units in hospitals are known to be more costly than standard care, but proponents claim that the health gains will justify the expense. Yet, despite widespread adoption of stroke units, the evidence on the cost effectiveness of stroke units has been mixed, due in part to differences in the pathway of care across hospitals. The purpose of this study is to compare costs and outcomes for patients admitted to a stroke unit with those admitted to a general ward. METHODS Data on 530 stroke sufferers from a large incidence study of stroke (the Auckland Regional Community Stroke Outcome Study) were used. Cost of health services, places of discharge were identified at one-, six- and 12 months poststroke and were linked with long-term cost and survival five-years poststroke. A decision analytical model was developed, including the relationship between waiting time for discharge and probability of admission to stroke unit. Cost effectiveness was determined using a willingness to pay threshold of NZ$20 000 (US$15 234). RESULTS Regression analysis suggested that there were no significant differences between patients admitted to a stroke unit and a general ward. The incremental cost-utility ratio for the first-year was NZ$42 813/quality-adjusted life year (US$32 610/quality-adjusted life year), but fell substantially to NZ$6747/quality-adjusted life year (US$5139/quality-adjusted life year) when lifetime costs and outcomes were considered. Probabilistic and one-way sensitivity analysis suggests that the results are robust to areas of uncertainty or delays in the pathway of care. CONCLUSION Stroke unit care was cost effective in Auckland, New Zealand.
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Affiliation(s)
- Braden J Te Ao
- National Institute for Stroke and Applied Neurosciences, School of Rehabilitation and Occupational Studies, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand.
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Use of acupuncture therapy as a supplement to conventional medical treatments for acute ischaemic stroke patients in an academic medical centre in Korea. Complement Ther Med 2011; 19:256-63. [DOI: 10.1016/j.ctim.2011.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2010] [Revised: 06/10/2011] [Accepted: 07/12/2011] [Indexed: 11/19/2022] Open
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Kang HY, Lim SJ, Suh HS, Liew D. Estimating the lifetime economic burden of stroke according to the age of onset in South Korea: a cost of illness study. BMC Public Health 2011; 11:646. [PMID: 21838919 PMCID: PMC3171726 DOI: 10.1186/1471-2458-11-646] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 08/13/2011] [Indexed: 11/10/2022] Open
Abstract
Background The recently-observed trend towards younger stroke patients in Korea raises economic concerns, including erosion of the workforce. We compared per-person lifetime costs of stroke according to the age of stroke onset from the Korean societal perspective. Methods A state-transition Markov model consisted of three health states ('post primary stroke event', 'alive post stroke', and 'dead') was developed to simulate the natural history of stroke. The transition probabilities for fatal and non-fatal recurrent stroke by age and gender and for non-stroke causes of death were derived from the national epidemiologic data of the Korean Health Insurance Review and Assessment Services and data from the Danish Monitoring Trends in Cardiovascular Disease study. We used an incidence-based approach to estimate the long-term costs of stroke. The model captured stroke-related costs including costs within the health sector, patients' out-of-pocket costs outside the health sector, and costs resulting from loss of productivity due to morbidity and premature death using a human capital approach. Average insurance-covered costs occurring within the health sector were estimated from the National Health Insurance claims database. Other costs were estimated based on the national epidemiologic data and literature. All costs are presented in 2008 Korean currency values (Korean won = KRW). Results The lifetime costs of stroke were estimated to be: 200.7, 81.9, and 16.4 million Korean won (1,200 KRW is approximately equal to one US dollar) for men who suffered a first stroke at age 45, 55 and 65 years, respectively, and 75.7, 39.2, and 19.3 million KRW for women at the same age. While stroke occurring among Koreans aged 45 to 64 years accounted for only 30% of the total disease incidence, this age group incurred 75% of the total national lifetime costs of stroke. Conclusions A higher lifetime burden and increasing incidence of stroke among younger Koreans highlight the need for more effective strategies for the prevention and management of stroke especially for people between 40 and 60 years of ages.
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Affiliation(s)
- Hye-Young Kang
- College of Pharmacy, Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, Republic of Korea.
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Luker JA, Bernhardt J, Grimmer-Somers KA. Age and gender as predictors of allied health quality stroke care. J Multidiscip Healthc 2011; 4:239-45. [PMID: 21847346 PMCID: PMC3155854 DOI: 10.2147/jmdh.s21559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Indexed: 12/21/2022] Open
Abstract
Background: Improvement in acute stroke care requires the identification of variables which may influence care quality. The nature and impact of demographic and stroke-related variables on care quality provided by allied health (AH) professionals is unknown. Aims: Our research explores the association of age and gender on an index of acute stroke care quality provided by AH professionals. Methods: A retrospective clinical audit of 300 acute stroke patients extracted data on AH care, patients’ age and gender. AH care quality was determined by the summed compliance with 20 predetermined process indicators. Our analysis explored relationships between this index of quality, age, and gender. Age was considered in different ways (as a continuous variable, and in different categories). It was correlated with care quality, using gender-specific linear and logistic regression models. Gender was then considered as a confounder in an overall model. Results: No significant association was found for any treatment of age and the index of AH care quality. There were no differences in gender-specific models, and gender did not significantly adjust the age association with care quality. Conclusion: Age and gender were not predictors of the quality of care provided to acute stroke patients by AH professionals.
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Affiliation(s)
- Julie A Luker
- International Centre for Allied Health Evidence, University of South Australia Adelaide, South Australia, Australia
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Jackson SL, Peterson GM. Stroke risk assessment for atrial fibrillation: hospital-based stroke risk assessment and intervention program. J Clin Pharm Ther 2011; 36:71-9. [PMID: 21198722 DOI: 10.1111/j.1365-2710.2009.01156.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the proven effectiveness of antithrombotic therapy for atrial fibrillation (AF), the treatment remains suboptimal. The aim of this study was to implement and evaluate a system to improve the appropriate use of antithrombotics for stroke prevention in AF utilizing a clinical pharmacist as a stroke risk assessor. METHOD Hospital in-patients with AF were prospectively identified and they received a formal stroke risk assessment from a pharmacist. The patients' risk of stroke was assessed and documented according to Australian guidelines and a recommendation regarding antithrombotic therapy was made to the medical team on a specially designed stroke risk assessment form. RESULTS One hundred and thirty-four stroke risk assessments were performed during the intervention period. For those patients at high risk of stroke and with no contraindication present (warfarin-eligible patients), 98% were receiving warfarin on discharge from hospital compared to 74% on admission (P < 0.001). Of the 50 (37%) assessments that recommended a change of therapy, 44 (88%) resulted in a change in the patient's current antithrombotic therapy compared to their admission therapy. Thirty (68%) of the assessments resulted in an 'upgrade' to more-effective treatment options for example from no therapy to any agent or from aspirin to warfarin. DISCUSSION AND CONCLUSION The pharmacist-led stroke risk assessment program resulted in a significant increase in the proportion of patients receiving appropriate thromboprophylaxis for stroke prevention in AF. The methods used in this study should be evaluated in a larger trial, in multiple hospitals, with different pharmacists performing the intervention.
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Affiliation(s)
- S L Jackson
- Unit for Medication Outcomes Research and Education, School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
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Chow WL, Tin AS, Meyyappan A. Factors Influencing Costs of Inpatient Ischaemic Stroke Care in Singapore. PROCEEDINGS OF SINGAPORE HEALTHCARE 2010. [DOI: 10.1177/201010581001900402] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Stroke is a major public issue in Singapore, accounting for almost 10,000 admissions annually and the burden of disease is set to increase with an ageing population. We therefore seek to examine the factors influencing the cost of acute stroke care in Singapore. Methods: This is a retrospective analysis of 2,087 discharges with a primary discharge diagnosis of stroke from a tertiary hospital in Singapore from 1 January 2007 to 31 December 2008. Data including age, gender, length of hospital stay, components of direct cost and discharge disposition were obtained. A generalised linear model with a log link function and gamma distribution was used to determine the predictors of total hospital cost. Results: Mean age was 67.8 ± 12.4 years and 54.5% were males. Mean length of stay was 12.3 ± 16 days and mean total overall cost was S$6,783. Ward costs accounted for 48% of total cost. Length of stay strongly correlated to total cost. Being discharged to step-down facilities, death, receiving inpatient rehabilitation and length of stay significantly incurred higher total cost in multivariate analysis. However, there was an inverse relationship between age and total cost, possibly as a result of higher costs incurred for radiological, laboratory investigations and expert care. Conclusion: Further research is needed to examine factors influencing the cost of treatment particularly for those being discharged to step-down facilities and receiving inpatient rehabilitation as they have been found to incur higher total cost. This would impact on the planning of the continuum of healthcare facilities for stroke management.
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Affiliation(s)
- Wai Leng Chow
- SingHealth Centre for Health Services Research, Singapore
| | - Aung Soe Tin
- SingHealth Centre for Health Services Research, Singapore
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Wei JW, Heeley EL, Jan S, Huang Y, Huang Q, Wang JG, Cheng Y, Xu E, Yang Q, Anderson CS. Variations and determinants of hospital costs for acute stroke in China. PLoS One 2010; 5. [PMID: 20927384 PMCID: PMC2946911 DOI: 10.1371/journal.pone.0013041] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 08/31/2010] [Indexed: 12/04/2022] Open
Abstract
Background The burden of stroke is high and increasing in China. We modelled variations in, and predictors of, the costs of hospital care for patients with acute stroke in China. Methods and Findings Baseline characteristics and hospital costs for 5,255 patients were collected using the prospective register-based ChinaQUEST study, conducted in 48 Level 3 and 14 Level 2 hospitals in China during 2006–2007. Ordinary least squares estimation was used to determine factors associated with hospital costs. Overall mean cost of hospitalisation was 11,216 Chinese Yuan Renminbi (CNY) (≈US$1,602) per patient, which equates to more than half the average annual wage in China. Variations in cost were largely attributable to stroke severity and length of hospital stay (LOS). Model forecasts showed that reducing LOS from the mean of 20 days for Level 3 and 18 days for Level 2 hospitals to a duration of 1 week, which is common among Western countries, afforded cost reductions of 49% and 19%, respectively. Other lesser determinants varied by hospital level: in Level 3 hospitals, health insurance and the occurrence of in-hospital complications were each associated with 10% and 18% increases in cost, respectively, whilst treatment in a teaching hospital was associated with approximately 39% decrease in cost on average. For Level 2 hospitals, stroke due to intracerebral haemorrhage was associated with a 19% greater cost than for ischaemic stroke. Conclusions Changes to hospital policies to standardise resource use and reduce the variation in LOS could attenuate costs and improve efficiencies for acute stroke management in China. The success of these strategies will be enhanced by broader policy initiatives currently underway to reform hospital reimbursement systems.
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Affiliation(s)
- Jade W Wei
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia.
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Langdon C, Blacker D. Dysphagia in stroke: a new solution. Stroke Res Treat 2010; 2010. [PMID: 20721336 PMCID: PMC2915662 DOI: 10.4061/2010/570403] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 05/17/2010] [Accepted: 05/30/2010] [Indexed: 11/27/2022] Open
Abstract
Dysphagia is extremely common following stroke, affecting 13%–94% of acute stroke sufferers. It is associated with respiratory complications, increased risk of aspiration pneumonia, nutritional compromise and dehydration, and detracts from quality of life. While many stroke survivors experience a rapid return to normal swallowing function, this does not always happen. Current dysphagia treatment in Australia focuses upon prevention of aspiration via diet and fluid modifications, compensatory manoeuvres and positional changes, and exercises to rehabilitate paretic muscles. This article discusses a newer adjunctive treatment modality, neuromuscular electrical stimulation (NMES), and reviews the available literature on its efficacy as a therapy for dysphagia with particular emphasis on its use as a treatment for dysphagia in stroke.
There is a good theoretical basis to support the use of NMES as an adjunctive therapy in dysphagia and there would appear to be a great need for further well-designed studies to accurately determine the safety and efficacy of this technique.
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Affiliation(s)
- Claire Langdon
- Speech Pathology Department and Department of Neurology, Sir Charles Gairdner Hospital, Hospital Avenue Nedlands Western Australia 6009, Australia
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McCann L, Groot P, Charnley C, Gardner A. Excellence in regional stroke care: An evaluation of the implementation of a stroke care unit in regional Australia. Aust J Rural Health 2009; 17:273-8. [DOI: 10.1111/j.1440-1584.2009.01098.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Perkins E, Stephens J, Xiang H, Lo W. The cost of pediatric stroke acute care in the United States. Stroke 2009; 40:2820-7. [PMID: 19590056 DOI: 10.1161/strokeaha.109.548156] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The cost of pediatric stroke care has received little attention, but the available data suggest it is expensive. To determine the cost of acute stroke, we analyzed a US national database. Method- We used the Kids' Inpatient Database (KID2003) to determine the hospital-based costs of acute stroke in children ages 3 months to 20 years. Discharges were selected if the first diagnostic position contained an International Classification of Diseases, 9th Revision code pertaining to ischemic or hemorrhagic stroke. We examined the relationship between cost and stroke type by adjusting for variables that predict the cost of adult stroke. RESULTS There were 2224 pediatric cases, after statistical weighting, discharged with a diagnosis of hemorrhagic or ischemic stroke in KID2003. The estimated cost of acute pediatric stroke in the United States was $42 million in 2003. For the entire cohort, the mean cost of acute hospital care was $20 927 per discharge. The mean cost for ischemic stroke was $15 003, for intracerebral hemorrhage $24 117, and for subarachnoid hemorrhage $31 653. Stroke diagnosis, length of stay, hospital ownership, rural/urban teaching status, US geographical region, and discharge disposition were significantly associated with cost. Cost remained significantly associated with stroke diagnosis after adjusting for other predictors in the final multivariable regression model. CONCLUSIONS Pediatric stroke is expensive, and the lifetime cost of care is likely greater for a child than an adult. The cost to the family and the larger society underscore the importance of pediatric stroke treatment and prevention.
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Affiliation(s)
- Elizabeth Perkins
- Department of Pediatrics and the Center for Biostatistics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio, USA
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Hackett ML, Glozier N, Jan S, Lindley R. Psychosocial Outcomes in StrokE: the POISE observational stroke study protocol. BMC Neurol 2009; 9:24. [PMID: 19519918 PMCID: PMC2708124 DOI: 10.1186/1471-2377-9-24] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 06/12/2009] [Indexed: 11/10/2022] Open
Abstract
Background Each year, approximately 12,000 Australians of working age survive a stroke. As a group, younger stroke survivors have less physical impairment and lower mortality after stroke compared with older survivors; however, the psychosocial and economic consequences are potentially substantial. Most of these younger stroke survivors have responsibility for generating an income or providing family care and indicate that their primary objective is to return to work. However, effective vocational rehabilitation strategies to increase the proportion of younger stroke survivors able to return to work, and information on the key target areas for those strategies, are currently lacking. Methods/Design This multi-centre, three year cohort study will recruit a representative sample of younger (< 65 years) stroke survivors to determine the modifiable predictors of subsequent return to work. Participants will be recruited from the New South Wales Stroke Services (SSNSW) network, the only well established and cohesively operating and managed, network of acute stroke units in Australia. It is based within the Greater Metropolitan area of Sydney including Wollongong and Newcastle, and extends to rural areas including Wagga Wagga. The study registration number is ACTRN12608000459325. Discussion The study is designed to identify targets for rehabilitation-, social- and medical-intervention strategies that promote and maintain healthy ageing in people with cardiovascular and mental health conditions, two of the seven Australian national health priority areas. This will rectify the paucity of information internationally around optimal clinical practice and social policy in this area.
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Affiliation(s)
- Maree L Hackett
- Neurological and Mental Health Division, The George Institute for International Health, The University of Sydney, Sydney, Australia.
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Kreisz FP, Merlin T, Moss J, Atherton J, Hiller JE, Gericke CA. The Pre-Test Risk Stratified Cost-Effectiveness of 64-Slice Computed Tomography Coronary Angiography in the Detection of Significant Obstructive Coronary Artery Disease in Patients Otherwise Referred to Invasive Coronary Angiography. Heart Lung Circ 2009; 18:200-7. [DOI: 10.1016/j.hlc.2008.10.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 10/21/2008] [Accepted: 10/27/2008] [Indexed: 11/25/2022]
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Earnshaw SR, Wilson M, Mauskopf J, Joshi AV. Model-based cost-effectiveness analyses for the treatment of acute stroke events: a review and summary of challenges. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2009; 12:507-520. [PMID: 19900253 DOI: 10.1111/j.1524-4733.2008.00467.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To summarize the methodological approaches used in published decision-analytic models evaluating interventions for acute stroke treatment, to highlight key components of decision-analytic models of stroke treatment, and to discuss challenges for developing stroke decision models. METHODS A review of the published literature was performed using Medline, to identify studies involving mathematical decision models to evaluate interventions for acute stroke treatment. Articles were analyzed to determine key components of a stroke model and to note areas in which data are lacking. RESULTS We identified 13 published models of acute stroke treatment. These models typically possessed a short-term treatment module and a long-term post-treatment module. The following aspects of economic modeling were found to be relevant for developing a stroke model: modeling approach and health state; health state transition probabilities; estimation of short-term, long-term, and indirect costs; health state utilities; poststroke mortality; time horizon; model validation; and estimation of parameter uncertainty. CONCLUSIONS Data gaps have limited the development of economic models in stroke to date. In order to more accurately assess the long-term incremental impact of a new treatment of stroke, future research is needed to address these data gaps. We recommend that the complexity of models for examining the cost-effectiveness of an acute stroke treatment be kept to a minimum such that it can incorporate the currently available data without making a large number of assumptions around the data.
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Miller CE, Quayyum Z, McNamee P, Al-Shahi Salman R. Economic Burden of Intracranial Vascular Malformations in Adults. Stroke 2009; 40:1973-9. [PMID: 19359648 DOI: 10.1161/strokeaha.108.539528] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Although intracranial vascular malformations (IVMs) are the leading cause of intracerebral hemorrhage (ICH) in young adults, there has not been a cost-of-illness study on an unselected cohort.
Methods—
We measured the direct healthcare costs (inpatient, outpatient, intervention, and brain imaging) incurred by every adult within 3 years after their first presentation with a brain arteriovenous malformation (AVM) or cavernous malformation (CM) in a prospective, population-based study. We estimated the indirect cost of lost productivity for the whole cohort over the same period by projecting questionnaire responses from living consenting adults.
Results—
369 adults (AVM=229 [62%], CM=140 [38%]) incurred healthcare costs of £5.96 million over 3 years, of which AVMs accounted for 90%, inpatient care accounted for 75%, and the first year of care accounted for 69%. Median 3-year healthcare costs were statistically significantly higher for adults presenting with ICH, aged <65 years, receiving interventional treatment, and adults with AVMs rather than CMs (£15 784 versus £1385,
P
<0.0005). Healthcare costs diminished with increasing AVM nidus size (
P
=0.005). Mean 3-year costs of lost productivity per questionnaire respondent (n=145) were £17 111 for AVMs and £6752 for CMs (
P
=0.1), and the projected 3-year cost of lost productivity for all 369 adults was £8.7 million.
Conclusions—
The costs of healthcare and lost productivity attributable to IVMs are considerable, and highest in those aged <65 years, presenting with ICH, receiving interventional treatment, and harboring AVMs rather than CMs. Long-term studies of the cost-effectiveness of interventional treatment are needed.
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Affiliation(s)
- Clare E. Miller
- From the Division of Clinical Neurosciences (C.E.M., R.A.-S.S.), University of Edinburgh; and the Health Economics Research Unit (P.M., Z.Q.), University of Aberdeen, UK
| | - Zahidul Quayyum
- From the Division of Clinical Neurosciences (C.E.M., R.A.-S.S.), University of Edinburgh; and the Health Economics Research Unit (P.M., Z.Q.), University of Aberdeen, UK
| | - Paul McNamee
- From the Division of Clinical Neurosciences (C.E.M., R.A.-S.S.), University of Edinburgh; and the Health Economics Research Unit (P.M., Z.Q.), University of Aberdeen, UK
| | - Rustam Al-Shahi Salman
- From the Division of Clinical Neurosciences (C.E.M., R.A.-S.S.), University of Edinburgh; and the Health Economics Research Unit (P.M., Z.Q.), University of Aberdeen, UK
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Effect of urgent treatment for transient ischaemic attack and minor stroke on disability and hospital costs (EXPRESS study): a prospective population-based sequential comparison. Lancet Neurol 2009; 8:235-43. [DOI: 10.1016/s1474-4422(09)70019-5] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Cadilhac DA, Carter R, Thrift AG, Dewey HM. Estimating the Long-Term Costs Of Ischemic and Hemorrhagic Stroke for Australia. Stroke 2009; 40:915-21. [DOI: 10.1161/strokeaha.108.526905] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Stroke is associated with considerable societal costs. Cost-of-illness studies have been undertaken to estimate lifetime costs; most incorporating data up to 12 months after stroke. Costs of stroke, incorporating data collected up to 12 months, have previously been reported from the North East Melbourne Stroke Incidence Study (NEMESIS). NEMESIS now has patient-level resource use data for 5 years. We aimed to recalculate the long-term resource utilization of first-ever stroke patients and compare these to previous estimates obtained using data collected to 12 months.
Methods—
Population structure, life expectancy, and unit prices within the original cost-of-illness models were updated from 1997 to 2004. New Australian stroke survival and recurrence data up to 10 years were incorporated, as well as cross-sectional resource utilization data at 3, 4, and 5 years from NEMESIS. To enable comparisons, 1997 costs were inflated to 2004 prices and discounting was standardized.
Results—
In 2004, 27 291 ischemic stroke (IS) and 4291 intracerebral hemorrhagic stroke (ICH) first-ever events were estimated. Average annual resource use after 12 months was AU$6022 for IS and AU$3977 for ICH. This is greater than the 1997 estimates for IS (AU$4848) and less than those for ICH (previously AU$10 692). The recalculated average lifetime costs per first-ever case differed for IS (AU$57 106 versus AU$52 855 [1997]), but differed more for ICH (AU$49 995 versus AU$92 308 [1997]).
Conclusion—
Basing lifetime cost estimates on short-term data overestimated the costs for ICH and underestimated those for IS. Patterns of resource use varied by stroke subtype and, overall, the societal cost impact was large.
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Affiliation(s)
- Dominique A. Cadilhac
- From the National Stroke Research Institute (D.A.C., A.G.T., H.M.D.), Victoria, Australia; the Department of Medicine (D.A.C., H.M.D.), The University of Melbourne, Australia; the Health Economics Unit (D.A.C., R.C.), Deakin University, Burwood, Australia; the Baker Heart & Diabetes Institute (A.G.T.), Melbourne, Australia; the Department of Epidemiology & Preventive Medicine (A.G.T.), Monash University, Melbourne, Australia; and the Department of Neurology (H.M.D.), Austin Health,
| | - Rob Carter
- From the National Stroke Research Institute (D.A.C., A.G.T., H.M.D.), Victoria, Australia; the Department of Medicine (D.A.C., H.M.D.), The University of Melbourne, Australia; the Health Economics Unit (D.A.C., R.C.), Deakin University, Burwood, Australia; the Baker Heart & Diabetes Institute (A.G.T.), Melbourne, Australia; the Department of Epidemiology & Preventive Medicine (A.G.T.), Monash University, Melbourne, Australia; and the Department of Neurology (H.M.D.), Austin Health,
| | - Amanda G. Thrift
- From the National Stroke Research Institute (D.A.C., A.G.T., H.M.D.), Victoria, Australia; the Department of Medicine (D.A.C., H.M.D.), The University of Melbourne, Australia; the Health Economics Unit (D.A.C., R.C.), Deakin University, Burwood, Australia; the Baker Heart & Diabetes Institute (A.G.T.), Melbourne, Australia; the Department of Epidemiology & Preventive Medicine (A.G.T.), Monash University, Melbourne, Australia; and the Department of Neurology (H.M.D.), Austin Health,
| | - Helen M. Dewey
- From the National Stroke Research Institute (D.A.C., A.G.T., H.M.D.), Victoria, Australia; the Department of Medicine (D.A.C., H.M.D.), The University of Melbourne, Australia; the Health Economics Unit (D.A.C., R.C.), Deakin University, Burwood, Australia; the Baker Heart & Diabetes Institute (A.G.T.), Melbourne, Australia; the Department of Epidemiology & Preventive Medicine (A.G.T.), Monash University, Melbourne, Australia; and the Department of Neurology (H.M.D.), Austin Health,
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Hankey GJ. Costs and health care system issues. HANDBOOK OF CLINICAL NEUROLOGY 2009; 92:373-388. [PMID: 18790285 DOI: 10.1016/s0072-9752(08)01919-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Graeme J Hankey
- Stroke Unit, Department of Neurology, Royal Perth Hospital and School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
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Luengo-Fernandez R, Gray AM, Rothwell PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke 2008; 40:e18-23. [PMID: 19109540 DOI: 10.1161/strokeaha.108.529776] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE With decision-analytic models becoming more popular to assess the cost-effectiveness of health care interventions, the need for robust estimates on the costs of cerebrovascular disease is paramount. This study reports the results from a literature review of the costs of cerebrovascular diseases, and assesses the quality of the published evidence against a set of defined criteria. METHODS A broad literature search was conducted. Those studies reporting mean/median costs of cerebrovascular diseases derived from patient-level data in a developed country setting were included. Data were abstracted using standardized reporting forms and assessed against 4 predefined criteria: use of adequate methodologies, use of a population-based study, inclusion of premorbid resource use, and reporting of costs by different patient subgroups. RESULTS A total of 120 cost studies were identified. The cost estimates of stroke were compared by taking into account the effects of inflation and price differentials between countries. Average costs of stroke ranged from $468 to $146 149. Differences in costs were also found within country, with estimates in the USA varying 20-fold. Although the costing methodologies used were generally appropriate, only 5 studies were based on population-based studies, which are the gold standard study design when comparing incidence, outcome, and costs. CONCLUSIONS This review showed large variations in the costs of stroke, mainly attributable to differences in the populations studied, methods, and cost categories included. The wide range of cost estimates could lead to selection bias in secondary health economic analyses, with authors including those costs that are more likely to produce the desired results.
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Affiliation(s)
- Ramon Luengo-Fernandez
- Department of Public Health, Health Economics Research Centre, University of Oxford, Oxford, USA.
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Glozier N, Hackett ML, Parag V, Anderson CS. The influence of psychiatric morbidity on return to paid work after stroke in younger adults: the Auckland Regional Community Stroke (ARCOS) Study, 2002 to 2003. Stroke 2008; 39:1526-32. [PMID: 18369172 DOI: 10.1161/strokeaha.107.503219] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person's mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors. METHODS The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). RESULTS Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39; 95% CI 0.22 to 0.80). Non-New Zealand European ethnicity (OR 0.40; 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work. CONCLUSIONS About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.
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Affiliation(s)
- Nick Glozier
- The George Institute for International Health, PO Box M201, Missenden Road, Sydney, NSW 2050, Australia.
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Chen PC, Chien KL, Chang CW, Su TC, Jeng JS, Lee YT, Sung FC. More hemorrhagic and severe events cause higher hospitalization care cost for childhood stroke in Taiwan. J Pediatr 2008; 152:388-93. [PMID: 18280847 DOI: 10.1016/j.jpeds.2007.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 06/19/2007] [Accepted: 08/03/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Rarely has childhood stroke been compared with adult stroke for incidence or cost. This population study compared the stroke incidence and the associated hospitalization care costs between children and adults in Taiwan. STUDY DESIGN We used reimbursement claims data from the National Health Insurance program to identify stroke diagnoses in 1997 to 2003. The inpatient costs of both the first admission and recurrent stroke from 1979 childhood cases and 365,169 adult cases were compared by age and stroke subtype, excluding those less than 1 month of age. RESULTS The mean inpatient costs were higher for patients <10 and 10 to 19 years of age ($3565 per case) compared with adult cases ($1933), including both first and recurrent hospitalizations, and they were higher for the recurrent cases. Patients <10 years old had the highest proportional incidence of hemorrhage events (71.4%), followed by patients in the 10- to 19-year-old group (61.4%), and the lowest for adults (21.3%). Hemorrhagic events incurred 2 to 12 times higher cost than other types of stroke. CONCLUSIONS The hospitalization care costs for stroke are higher for children than for adults because of a greater proportion of hemorrhagic cases among children.
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Affiliation(s)
- Pei-Chun Chen
- Institution of Environmental Health, National Taiwan University Hospital, Taipei
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Feigin VL, Barker-Collo S, McNaughton H, Brown P, Kerse N. Long-term neuropsychological and functional outcomes in stroke survivors: current evidence and perspectives for new research. Int J Stroke 2008; 3:33-40. [PMID: 18705913 DOI: 10.1111/j.1747-4949.2008.00177.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To appraise the literature on long-term neuropsychological and functional outcomes in stroke survivors and identify the gaps, challenges and future research in this area. BACKGROUND Stroke care resources are scarce, and the number of stroke survivors is likely to increase with the ageing of the population. Thus, evaluating the cost, frequency and prognostic factors of long-terms stroke functional and neuropsychological outcomes is of paramount importance for evidence-based clinical decision making, including the rationale, planning, provision and allocation of health services, and the development of effective interventions. Summary of review Stroke has an enormous physical, emotional and economic impact on the patients, families and society. However, accurate data on frequency, relationship and predictors of various long-term functional (body functioning, activity and participation) outcomes and costs of stroke are scarce, and no accurate and comprehensive data exist on long-term neuropsychological outcomes and their relationships with other functional outcomes poststroke. CONCLUSIONS There is a lack of accurate data on the frequency, relationship and predictors of various long-term functional outcomes and costs of stroke. There is a pressing need for good-quality population-based studies for evaluating the frequency and prognostic factors of long-term functional and neuropsychological outcomes of stroke in various populations.
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Affiliation(s)
- Valery L Feigin
- Clinical Trials Research Unit, School of Population Health and Department of Medicine, Faculty of Health & Medical Sciences, University of Auckland, Auckland, New Zealand
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