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Influence of Age on the Success of Neurorehabilitation. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2023. [DOI: 10.3390/ctn7010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
There is a general understanding that older adults suffering from a stroke have poorer outcomes and might benefit less from neurorehabilitation. This narrative review analyzes the conflicting evidence for the effect of aging on the success of neurorehabilitation after a stroke. While there is convincing evidence that functional outcomes are negatively impacted by age, functional gains made during rehabilitation are less clearly impacted, and the effect of age seems to be related to other factors such as prestroke independence and therapy intensity, as well as the population studied. There is no evidence that would justify withholding high-intensity neurorehabilitation on the sole basis of age.
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Kunz WG, Sporns PB, Psychogios MN, Fiehler J, Chapot R, Dorn F, Grams A, Morotti A, Musolino P, Lee S, Kemmling A, Henkes H, Nikoubashman O, Wiesmann M, Jensen-Kondering U, Möhlenbruch M, Schlamann M, Marik W, Schob S, Wendl C, Turowski B, Götz F, Kaiser D, Dimitriadis K, Gersing A, Liebig T, Ricke J, Reidler P, Wildgruber M, Mönch S. Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study. J Stroke 2022; 24:138-147. [PMID: 35135067 PMCID: PMC8829473 DOI: 10.5853/jos.2021.01606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background and Purpose The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population.
Methods In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY.
Results The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives.
Conclusions EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.
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Affiliation(s)
- Wolfgang G. Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Correspondence: Wolfgang G. Kunz Department of Radiology, University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany Tel: +49-89-4400-73630 Fax: +49-89-4400-78832 E-mail:
| | - Peter B. Sporns
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marios N. Psychogios
- Department of Neuroradiology, Clinic for Radiology & Nuclear Medicine, University Hospital Basel, Switzerland
| | - Jens Fiehler
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - René Chapot
- Department of Neuroradiology, Alfried-Krupp Hospital, Essen, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Astrid Grams
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Andrea Morotti
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Patricia Musolino
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Lee
- Division of Child Neurology, Department of Neurology, Stanford University, Stanford, CA, USA
| | - André Kemmling
- Department for Neuroradiology, University Hospital Marburg, Marburg, Germany
| | - Hans Henkes
- Department of Neuroradiology, Klinikum Stuttgart, Stuttgart, Germany
| | | | - Martin Wiesmann
- Department of Neuroradiology, Aachen University, Aachen, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Markus Möhlenbruch
- Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
| | - Marc Schlamann
- Department of Neuroradiology, University Hospital of Cologne, Cologne, Germany
| | - Wolfgang Marik
- Division of Neuroradiology and Musculoskeletal Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Stefan Schob
- Department for Neuroradiology, University Hospital Leipzig, Leipzig, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Bernd Turowski
- Institute of Neuroradiology, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Friedrich Götz
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Daniel Kaiser
- Department of Neuroradiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | | | - Alexandra Gersing
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Liebig
- Institute of Diagnostic and Interventional Neuroradiology, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Paul Reidler
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sebastian Mönch
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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Chien SH, Sung PY, Liao WL, Tsai SW. A functional recovery profile for patients with stroke following post-acute rehabilitation care in Taiwan. J Formos Med Assoc 2019; 119:254-259. [PMID: 31147198 DOI: 10.1016/j.jfma.2019.05.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/10/2019] [Accepted: 05/14/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Functional impairment is frequently seen in patients with stroke. Although the progression of functional recovery after stroke has been proposed, the recovery profile after acute stroke is not well described. The objective of this study is to investigate functional recovery in stroke patients entering post-acute rehabilitation care. METHODS A retrospective cohort study collected the data of patients who entered the stroke Post-acute Care (PAC) programs. Ninety-five patients after stroke with a modified Ranking Scale (mRS) score of 3-4 who were referred to a post-acute care unit for intensive rehabilitation were recruited. The patients underwent functional, quality of life, and neuropsychological evaluation tests at admission and before discharge. The test scores before discharge were used as outcome variables and were compared with the test scores at admission to show functional recovery. RESULTS The average length of stay was 58.15 days. After an intensive rehabilitation intervention, significant improvements were observed in all test scores. Additionally, a significant removal rate for nasogastric tubes (p = 0.000) and Foley catheters (p = 0.003) was found at discharge. CONCLUSION This study showed that the PAC rehabilitation unit was beneficial for patients with acute stroke who had functional impairments. The study results may call for further investigation to identify and develop better models for the delivery of rehabilitation in the stroke PAC unit.
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Affiliation(s)
- Sou-Hsin Chien
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; Department of Plastic Surgery, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Pi-Yu Sung
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan; Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan
| | - Wen-Ling Liao
- Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan
| | - Sen-Wei Tsai
- Department of Post-Acute Care Center, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan; School of Medicine, Tzu Chi University, Hualien 970, Taiwan; Department of Physical Medicine and Rehabilitation, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung City 427, Taiwan.
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Ruggeri M, Basile M, Zini A, Mangiafico S, Agostoni EC, Lobotesis K, Saver J, Coretti S, Drago C, Cicchetti A. Cost-effectiveness analysis of mechanical thrombectomy with stent retriever in the treatment of acute ischemic stroke in Italy. J Med Econ 2018; 21:902-911. [PMID: 29882711 DOI: 10.1080/13696998.2018.1484748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Stroke has a significant disease burden in terms of acute and long-term disability in Italy and throughout the world. Endovascular treatments for the management of a stroke event have been coupled in the past years with the possibility to mechanically remove the occlusion by means of specially designed thrombectomy devices, and their exclusive use showed levels of effectiveness in line with those of the existing pharmacological treatments. OBJECTIVE To assess the cost-effectiveness of mechanical thrombectomy (MT) with the Solitaire Revascularization Device (stent retriever) for the treatment of acute ischemic stroke (AIS) in patients with large vessel occlusions (LVOs), comparing MT plus intravenous tissue plasminogen activation (MT plus IV t-PA) vs IV t-PA alone, in Italy. METHODS A Markov model was used to simulate costs and benefits of MT plus IV t-PA and IV t-PA alone over a 5-year time horizon and considering the perspective of the Italian National Health Service (NHS). Results are reported in terms of Incremental Cost Effectiveness Ratio (ICER). Deterministic and probabilistic sensitivity analyses are carried out in order to test the robustness of the results. RESULTS Total costs of MT plus IV t-PA and IV t-PA alone are equal to €31,798 and €34,855, respectively. The MT allows incremental QALYs for 0.77, determining a dominant ICER. The utilities associated to the mRS health states are the parameters with the highest impact on the results. Multiway sensitivity analyses determined a 90% probability of dominance. CONCLUSIONS MT plus IV t-PA for AIS patients with LVO is cost-effective from year 1 through year 3, and cost-saving from year 4 onward in the Italian context, achieving better results, both in terms of efficacy and in terms of resource consumption.
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Affiliation(s)
- Matteo Ruggeri
- a ALTEMS Postgraduate School of Health Economics , Rome , Italy
| | - Michele Basile
- a ALTEMS Postgraduate School of Health Economics , Rome , Italy
| | - Andrea Zini
- b Stroke Unit, Neurology Clinic, Department of Neuroscience , Nuovo Ospedale Civile "S.Agostino-Estense", Modena University Hospital , Modena , Italy
| | - Salvatore Mangiafico
- c Neurovascular Interventional Unit , Careggi University Hospital , Florence , Italy
| | | | | | - Jeffrey Saver
- f Department of Neurology and Comprehensive Stroke Center , David Geffen School of Medicine, University of California, Los Angeles (UCLA) , Los Angeles , CA , USA
| | - Silvia Coretti
- a ALTEMS Postgraduate School of Health Economics , Rome , Italy
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Kunz WG, Hunink MG, Dimitriadis K, Huber T, Dorn F, Meinel FG, Sabel BO, Othman AE, Reiser MF, Ertl-Wagner B, Sommer WH, Thierfelder KM. Cost-effectiveness of Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review of the Impact of Patient Age. Radiology 2018; 288:518-526. [DOI: 10.1148/radiol.2018172886] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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[Costs associated with multiresistant bacteria in neurorehabilitation]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:1075-1082. [PMID: 28812106 DOI: 10.1007/s00103-017-2606-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The number of patients with multiresistant bacteria (MRB) in rehabilitation facilities is increasing. The increasing costs of hygienic isolation measures reduce resources available for core rehabilitation services. In addition to the existing lack of care, patients with MRB are at further risk of being given lower priority for admission to rehabilitation facilities. Therefore, the Hygiene Commission of the German Society for Neurorehabilitation (DGNR) attempted to quantify the overall risk for deterioration of rehabilitation care due to the financial burden of MRB. MATERIALS AND METHODS To analyze the added costs associated with the rehabilitation of patients with MBR, the DGNR Hygiene Commission identified criteria for a cost assessment. Direct (consumables, personnel and miscellaneous costs) and indirect costs of loss of opportunity were evaluated in seven neurorehabilitation centers in different states across Germany. RESULTS On average, hygienic isolation measures amounted to direct costs of 144 € per day (47 € consumables, 92 € personnel, 5 € for other costs such as extra transportation expenditure) and indirect costs of 274 €, totaling 418 € per patient with MRB per day. Given that approximately 10% of patients had MRB, the added costs of hygienic isolation measures equaled about one tenth of the overall budget of a rehabilitation center and can be expected to rise with the increasing numbers of patients with MRB. CONCLUSIONS Admission of patients carrying MRB to neurorehabilitation centers triggers added costs that critically diminish the overall capacity for centers to provide their core rehabilitation services.
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Munsell M, Frean M, Menzin J, Phillips AL. Development and validation of a claims-based measure as an indicator for disease status in patients with multiple sclerosis treated with disease-modifying drugs. BMC Neurol 2017; 17:106. [PMID: 28583104 PMCID: PMC5460356 DOI: 10.1186/s12883-017-0887-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/23/2017] [Indexed: 11/10/2022] Open
Abstract
Background Administrative healthcare claims data provide a mechanism for assessing and monitoring multiple sclerosis (MS) disease status across large, clinically representative “real-world” populations. The estimation of MS disease status using administrative claims can be a challenge, however, due to a lack of detailed clinical information. Retrospective claims analyses in MS have traditionally used rates of MS relapses to approximate disease status. Healthcare costs may be alternate, broader claims-based indicators of disease activity because costs reflect multiple facets of care of patients with MS, and there is a strong correlation between quality of life of patients with MS and costs of the disease. This study developed, tested, and validated a healthcare cost-based measure to serve as an indicator of overall disease status in patients with MS treated with disease-modifying drugs (DMDs) utilizing administrative claims. Methods Using IMS Health Real World Data Adjudicated Claims – US data (January 2006–June 2013), a negative binomial regression predicted annual all-cause medical costs. Coefficients reaching statistical significance (p < 0.05) and increasing costs by ≥5% were selected for inclusion into an MS-specific severity score (scale of 0 to 100). Components of the score included rehabilitation services, altered mental state, pain, disability, stiffness, balance disorder, urinary incontinence, numbness, malaise/fatigue, and infections. Coefficient weights represented each predictor’s contribution. The predictive model was derived using 50% of a random sample and tested/validated using the remaining 50%. Results Average overall predicted annual total medical cost was $11,134 (development sample, n = 11,384, vs. $10,528 actual) and $11,303 (validation sample, n = 11,385, vs. $10,620 actual). The model had consistent bias (approximately +$600 or +6% of actual costs) for both samples. In the validation sample, mean MS disease status scores were 0.24, 8.95, and 21.77 for low, medium, and high tertiles, respectively. Mean costs were most accurately predicted among less severe patients ($5243 predicted vs. $5233 actual cost for lowest tertile). Conclusion The algorithm developed in this study provides an initial step to helping understand and potentially predict cost changes for a commercially insured MS population. Electronic supplementary material The online version of this article (doi:10.1186/s12883-017-0887-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michael Munsell
- Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA
| | - Molly Frean
- Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA
| | - Joseph Menzin
- Boston Health Economics, Inc., 20 Fox Road, Waltham, MA, 02451, USA.
| | - Amy L Phillips
- Health Economics & Outcomes Research, EMD Serono, Inc., One Technology Place, Rockland, MA, 02370, USA
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van Eeden M, van Mastrigt GAPG, Evers SMAA, van Raak EPM, Driessen GAM, van Heugten CM. The economic impact of mental healthcare consumption before and after stroke in a cohort of stroke patients in the Netherlands: a record linkage study. BMC Health Serv Res 2016; 16:688. [PMID: 27964721 PMCID: PMC5155378 DOI: 10.1186/s12913-016-1915-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 11/09/2016] [Indexed: 11/20/2022] Open
Abstract
Background Post-stroke healthcare consumption is strongly associated with a mental health diagnosis. This study aimed to identify stroke patients who utilised mental healthcare facilities, explored their mental healthcare consumption pre-stroke and post-stroke, and examined possible predictors of costs incurred by mental healthcare consumption post-stroke. Methods Three databases were integrated, namely the Maastricht University Medical Centre (MUMC) Medical Administration, the Stroke Registry from the Department of Neurology at MUMC, and the Psychiatric Case Registry South-Limburg. Patients from the MUMC who suffered their first-ever stroke between January 1 2000 and December 31 2004 were included and their records were analysed for mental healthcare consumption from 5 years preceding to 5 years following their stroke (1995–2009). Regression analysis was conducted to identify possible predictors of mental healthcare consumption costs. Results A total of 1385 patients were included and 357 (25.8%) received services from a mental healthcare facility during the 10-year reference period around their stroke. The costs of mental healthcare usage increased over time and peaked 1 year post-stroke (€7057; 22% of total mental healthcare costs). The number of hospitalisation days and mental healthcare consumption pre-stroke were significant predictors of mental healthcare costs. Explained variances of these models (costs during the 5 years post-stroke: R2 = 15.5%, costs across a 10 year reference period: R2 = 4.6%,) were low. Conclusion Stroke patients have a significant level of mental healthcare comorbidity leading to relatively high mental healthcare costs. There is a relationship between stroke and mental healthcare consumption costs, but results concerning the underlying factors responsible for these costs are inconclusive.
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Affiliation(s)
- M van Eeden
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - G A P G van Mastrigt
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - S M A A Evers
- Department of Health Services Research, CAPHRI, Research School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.
| | - E P M van Raak
- Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - G A M Driessen
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - C M van Heugten
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, Maastricht, The Netherlands
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Knecht S, Roßmüller J, Unrath M, Stephan KM, Berger K, Studer B. Old benefit as much as young patients with stroke from high-intensity neurorehabilitation: cohort analysis. J Neurol Neurosurg Psychiatry 2016; 87:526-30. [PMID: 26069298 PMCID: PMC4853552 DOI: 10.1136/jnnp-2015-310344] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 04/08/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE In current clinical practice, old patients with stroke are less frequently admitted to neurorehabilitation units following acute care than younger patients based on an assumption that old age negatively impacts the benefit obtained from high-intensity neurorehabilitation. Our objective was to test this assumption empirically in a large sample of patients with stroke. METHODS Functional recovery during 4 weeks of inpatient neurorehabilitation was assessed with the Barthel Index (BI) in 422 middle-aged (<65 years), 1399 old (65-80 years) and 473 very old (>80 years) patients with stroke. Overall functional recovery, recovery patterns and the relationship between therapy intensity and recovery were statistically compared between the three age groups. RESULTS Overall functional recovery was statistically equivalent in middle-aged, old and very old patients (average improvement in BI total score: middle-aged: 15 points; old: 15 points; very old: 14 points). A novel item-wise logistic regression analysis (see Pedersen, Severinsen & Nielsen, 2014, Neurorehabil Neural Repair) revealed that this was true for 9 of the 10 everyday functions assessed by the BI. Furthermore, functional recovery was predicted by the amount of therapy (R=0.14; p=0.0001), and age did not moderate this relationship between therapy intensity and recovery (p=0.70). CONCLUSIONS Old and even very old patients with stroke benefit from specialised inpatient neurorehabilitation and high amounts of therapy in the same degree as younger patients. Contrary to current clinical practice, old age should not be a criterion against admission to a neurorehabilitation unit following acute stroke treatment.
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Affiliation(s)
- Stefan Knecht
- Department of Neurology, Mauritius Hospital, Meerbusch, Germany Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jens Roßmüller
- Department of Neurology, Mauritius Hospital, Meerbusch, Germany
| | - Michael Unrath
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | | - Klaus Berger
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Bettina Studer
- Department of Neurology, Mauritius Hospital, Meerbusch, Germany Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University, Düsseldorf, Germany
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Ng CS, Toh MPHS, Ng J, Ko Y. Direct medical cost of stroke in Singapore. Int J Stroke 2015; 10 Suppl A100:75-82. [PMID: 26179153 DOI: 10.1111/ijs.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. AIMS To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. METHODS The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. RESULTS A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). CONCLUSION There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.
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Affiliation(s)
- Charmaine Shuyu Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Matthias Paul Han Sim Toh
- Information Management, Central Regional Health Office, National Healthcare Group, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jiaying Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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Calciolari S, Torbica A, Tarricone R. Explaining the health costs associated with managing intracranial aneurysms in Italy. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2013; 11:427-435. [PMID: 23839310 DOI: 10.1007/s40258-013-0041-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND The clinical management of intracranial aneurysms is debated in many countries because of the associated disability risk and costs. Therefore, estimating the costs and explaining their variability will provide important information for decision makers. OBJECTIVE We aimed to evaluate the acute and post-acute health costs of intracranial aneurysm management and to explain the variability in these costs in the Italian National Health System. METHODS An observational study was conducted on 145 patients who were affected by a (single) ruptured or an unruptured intracranial aneurysm. They were consecutively admitted to 14 Italian hospitals between October 2005 and March 2007. The data collected during the initial hospitalization and three follow-up visits were used to assess the 1-year health costs and the patients' health status after discharge. Two multivariate regression models were used to explain the variability in the acute and post-acute costs. RESULTS The average total cost per patient was <euro>30,813 (evaluation year: 2012). The first model explained the acute costs fairly well and showed that the severity of illness, the admission unit (i.e., intensive care unit vs. another unit of the hospital), and mortality were associated with large, significant (p < 0.05) coefficients. The second model outperformed the first one in explaining the post-acute costs and showed that health status assessed 30 days after discharge was a significant (p < 0.05) predictor of costs. CONCLUSION Policies aimed at containing health costs should focus on interventions that help to reduce disability, which is a key predictor of long-term costs.
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Affiliation(s)
- Stefano Calciolari
- Università della Svizzera italiana, Via Giuseppe Buffi, 13, 6904, Lugano, Switzerland.
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Healthcare costs for people aged 65+ two years prior to their receiving long-term municipal care. Aging Clin Exp Res 2013; 20:547-55. [DOI: 10.1007/bf03324883] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Fattore G, Torbica A, Susi A, Giovanni A, Benelli G, Gozzo M, Toso V. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol 2012; 12:137. [PMID: 23150894 PMCID: PMC3536660 DOI: 10.1186/1471-2377-12-137] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 10/15/2012] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission. Methods The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs) and productivity losses. The relation between costs of stroke management and socio-demographic and clinical characteristics as well as disability levels was evaluated in a series of bivariate analyses using non parametric tests (Mann Whitney and Kruskal-Wallis). Multiple linear regression analyses were performed to determine predictors of costs incurred by stroke patients during the acute phase and follow-up of 1 year. Results On average, one-year healthcare and societal costs amounted to €11,747 and € 19,953 per stroke survivor, respectively. The major cost component of societal costs was informal care accounting for € 6,656 (33.4% of total), followed by the initial hospitalisation, (€ 5,573; 27.9% of total), rehabilitation during follow up (€ 4,112; 20.6 %), readmissions (€ 439) and specialist and general practioner visits (€ 326). Mean drug costs per patient over the follow-up period was about € 50 per month. Costs associated to the provision of paid and informal care followed different pattern and were persistent over time (ranging from € 639 to € 597 per month in the first and the second part of the year, respectively). Clinical variables (presence of diabetes mellitus and hemorrhagic stroke) were significant predictors of total healthcare costs while functional outcomes (Barthel Index and Modified Ranking Scale scores) were significantly associated with both healthcare and societal costs at one year. Conclusions The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate “social” support.
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Affiliation(s)
- Giovanni Fattore
- Centre for Research on Health and Social Care Management (CERGAS) and SDA Bocconi, Università Bocconi, Milan, Italy.
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Bottacchi E, Corso G, Tosi P, Morosini MV, De Filippis G, Santoni L, Furneri G, Negrini C. The cost of first-ever stroke in Valle d'Aosta, Italy: linking clinical registries and administrative data. BMC Health Serv Res 2012; 12:372. [PMID: 23110322 PMCID: PMC3507771 DOI: 10.1186/1472-6963-12-372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stroke is one of the most relevant reasons of death and disability worldwide. Many cost of illness studies have been performed to evaluate direct and indirect costs of ischaemic stroke, especially within the first year after the acute episode, using different methodologies. METHODS We conducted a longitudinal, retrospective, bottom-up cost of illness study, to evaluate clinical and economic outcomes of a cohort of patients affected by a first cerebrovascular event, including subjects with ischaemic, haemorrhagic or transient episodes. The analysis intended to detect direct costs, within 1, 2 and 3 years from the index event. Clinical patient data collected in regional disease registry were integrated and linked to regional administrative databases to perform the analysis. RESULTS The analysis of costs within the first year from the index event included 800 patients. The majority of patients (71.5%) were affected by ischaemic stroke. Overall, per patient costs were €7,079. Overall costs significantly differ according to the type of stroke, with costs for haemorrhagic stroke and ischaemic stroke amounting to €9,044 and €7,289. Hospital costs, including inpatient rehabilitation, were driver of expenditure, accounting for 89.5% of total costs. The multiple regression model showed that sex, level of physical disability and level of neurological deficit predict direct healthcare costs within 1 year. The analysis at 2 and 3 years (per patient costs: €7,901 and €8,874, respectively) showed that majority of costs are concentrated in the first months after the acute event. CONCLUSIONS This cost analysis highlights the importance to set up significant prevention programs to reduce the economic burden of stroke, which is mostly attributable to hospital and inpatient rehabilitation costs immediately after the acute episode. Although some limitation typical of retrospective analyses the approach of linking clinical and administrative database is a power tool to obtain useful information for healthcare planning.
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Affiliation(s)
- Edo Bottacchi
- Department of Neurology, Regional Hospital of Aosta Valley, Aosta, Italy
| | - Giovanni Corso
- Department of Neurology, Regional Hospital of Aosta Valley, Aosta, Italy
| | - Piera Tosi
- Department of Neurology, Regional Hospital of Aosta Valley, Aosta, Italy
| | | | | | | | - Gianluca Furneri
- Scientific Direction, Italian National Research Center on Aging (I.N.R.C.A.), Ancona, Italy
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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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Yoon SS, Chang H, Kwon YD. Itemized hospital charges for acute cerebral infarction patients influenced by severity in an academic medical center in Korea. J Clin Neurol 2012; 8:58-64. [PMID: 22523514 PMCID: PMC3325433 DOI: 10.3988/jcn.2012.8.1.58] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 09/14/2011] [Accepted: 09/14/2011] [Indexed: 11/19/2022] Open
Abstract
Background and Purpose Stroke imposes a major burden on patients, their families, and the national healthcare system. The purpose of this study was to determine the itemized hospital charges in acute ischemic stroke patients according to their severity by partitioning the charges in detail and then examining whether stroke severity was a significant contributor to these charges. Methods This study analyzed data of first-time acute ischemic stroke patients who had been admitted to an academic medical center between September 2003 and April 2009. The patients' demographic and clinical characteristics were analyzed descriptively, and then eight categorized hospital charges as well as the total charge were compared among patients grouped according to stroke severity, using analysis of variance. Multiple regression analyses were conducted to test the influence of stroke severity on itemized hospital charges as well as the total charge, while controlling for other related factors. Results More-severe strokes were associated with a higher total charge. Significantly higher charges were associated with patients with more-severe strokes regarding all charged items except imaging studies. The charges for imaging studies were similar across all severities of stroke. While controlling for other factors, a significant impact of stroke severity was found in both the total hospital charge and most itemized charges. Conclusions Itemized hospital charges for inpatients with acute ischemic stroke varied according to stroke severity. Stroke severity was a significant factor influencing the itemized charges of acute hospitalization of ischemic stroke patients.
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Affiliation(s)
- Sung Sang Yoon
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
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Krivonos OV, Amosova NA, Smolentseva IG. Use of the glutamate NMDA receptor antagonist PK-Merz in acute stroke. ACTA ACUST UNITED AC 2011; 40:529-32. [PMID: 20464511 DOI: 10.1007/s11055-010-9292-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- O V Krivonos
- Department of the Organization of Medical Care and Healthcare Development, Ministry of Health and Social Development of the Russian Federation, Moscow, Russia
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Lin CL, Lin PH, Chou LW, Lan SJ, Meng NH, Lo SF, Wu HDI. Model-based prediction of length of stay for rehabilitating stroke patients. J Formos Med Assoc 2009; 108:653-62. [PMID: 19666353 DOI: 10.1016/s0929-6646(09)60386-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/PURPOSE Accurate length-of-stay (LOS) estimates have an impact on medical costs for stroke patients. Most studies have reported only descriptive sample means or have provided linear-model-based estimates for LOS. This study calculated point and interval estimates by treating hospital discharge as an event, and utilizing the proportional hazards (PH) model to provide the estimation of hospital stay for first-ever stroke patients in a rehabilitation department of a clinical center. METHODS Pairwise analysis for correlations between age, sex, comorbidity status, modified Barthel index (MBI) and functional independence measure (FIM) was performed. These explanatory variables are used in the K-sample comparisons, the Chi-squared test for association, the PH regression analysis, and log-transformed linear (LTL) regression. RESULTS The PH model gave a prediction on estimated mean LOS, with an absolute bias of 0.85 days, by combining MBI and FIM into a single variable, or a bias of 1.15 days and 1.16 days with MBI and FIM variables, respectively. The LTL-based estimation generated a bias of 5.91 days. The PH model has relatively shorter confidence intervals than those obtained by sample-mean and LTL methods. CONCLUSION We recommend using the PH model for predicting mean LOS when the PH assumption for patients with different clinical characteristics is satisfied. However, the proposed method only applies to rehabilitating stroke patients.
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Affiliation(s)
- Chien-Lin Lin
- Department of Rehabilitation, China Medical University Hospital, Taiwan
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González-Guerrero JL, Jaramillo E, Alonso-Fernández T. [Stroke in the very old]. Rev Esp Geriatr Gerontol 2009; 44:231-232. [PMID: 19595486 DOI: 10.1016/j.regg.2009.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 02/05/2009] [Accepted: 02/06/2009] [Indexed: 05/28/2023]
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Tavakoli M, Pumford N, Woodward M, Doney A, Chalmers J, MacMahon S, Macwalter R. An economic evaluation of a perindopril-based blood pressure lowering regimen for patients who have suffered a cerebrovascular event. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2009; 10:111-119. [PMID: 18446392 DOI: 10.1007/s10198-008-0108-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 04/09/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Cerebrovascular disease (or stroke) is one of the main causes of long-term disability and the second leading cause of death worldwide. The economic impact of stroke is clearly seen, as it is the largest single cause of bed occupancy in hospitals in England and accounts for 6% of hospital costs. This analysis is the first to quantify the economic consequences of a blood pressure lowering regimen based on the PROGRESS study (perindopril-based regimen), for reducing future cardiovascular events. DESIGN A Markov decision analytical model was used to estimate the cost per quality adjusted life year (QALY) of blood pressure lowering in the treatment of patients presenting with a cerebrovascular event. The health states are based upon Barthel indices for which resource utilisation and health benefits have previously been estimated. SETTING The participants for the economic analysis were obtained from the PROGRESS study database. 6,105 clinical study participants were recruited through both primary and secondary care centres. PARTICIPANTS The mean age was 64 years; 70% were male in the original study. INTERVENTIONS In the PROGRESS study, blood pressure lowering by a perindopril-based regimen was compared to standard care. MAIN OUTCOME MEASURES Cost per quality adjusted life year for the duration of the study (4 years) and for a time span of 20 years. RESULTS Using only direct hospital medical costs, the cost per QALY for a perindopril based regimen is pound 6,927 for the base study period and pound 10,133 for a 20-year time period. These results are sensitive to the cost of perindopril, the cost of the stroke unit, length of stay, and to a lesser extent, the cost of indapamide. CONCLUSIONS This analysis demonstrates a cost-effective treatment for patients suffering a cerebrovascular event with a blood pressure lowering regimen. The findings of this study are in line with current decisions and guidance by the national institute for health and clinical excellence (NICE) in England.
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Ward A, Payne KA, Caro JJ, Heuschmann PU, Kolominsky-Rabas PL. Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project. Eur J Neurol 2005; 12:264-7. [PMID: 15804242 DOI: 10.1111/j.1468-1331.2004.00949.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The objective was to determine the functional outcome, location of care and economic consequences in the first 3 months after ischemic stroke. As part of the Erlangen Stroke Project, (ESPro) information was collected on patients suffering a first-ever ischemic stroke. Three months after the stroke, location of care, dependence on caregivers and function based on Barthel Index: poor (0-55), moderate (60-90) or good function (95-100) were recorded. Data about health services used were combined with cost estimates for Germany (2000 Euros, undiscounted). Of 491 patients hospitalized, 383 were alive 3 months afterwards, 79% residing in the community. The majority of patients with poor function (60%) were still in institutional care. Patients with good function typically accrued the lowest costs, whether in an institution (17 965) or not (11 032) compared with poorer function who were living in an institution (poor: 26 370; moderate: 28,121), or community (poor: 27,207; moderate: 19,350). Hospitalization and rehabilitation services were the major costs accrued at each level of function. Many patients were left requiring a substantial amount of care and the costs associated with providing institutional care has a major impact on the economic consequences of a stroke.
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Affiliation(s)
- A Ward
- Caro Research Institute, Concord, MA 01742, USA.
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Abstract
BACKGROUND Stroke is the third leading cause of death and the first leading cause of disability in developed and developing countries. It is one of the most demanding public health problems to be faced in the upcoming years, particularly because of population aging. STATE OF THE ART New therapeutic advances in the management of acute stroke have changed our perception of this condition and have had a major impact on healthcare organization and subsequently healthcare expenditures. Care required for the stroke victim is costly in both developing countries and in developed countries. Hemmorhagic events are the most costly, but their prevalence in Western countries is lower than ischemic events. Prevalence of ischemic events is higher in Asian countries. The direct costs of stroke, both for primary and secondary events, constitute the larger part of healthcare expenditures. The mean cost of stroke in France is estimated at 18,000 euros for the first 12 months. Disability accounts for 42 percent of the variable cost of stroke. During the first year, the acute phase accounts for 40 percent of the cost, rehabilitation and mid-term hospitalization for 29 percent, and ambulatory care for 8 percent. After 46 months, the cost of ambulatory care exceeds the cost of the first six months of care during and following the acute phase. CONCLUSION Any improvement in the primary or secondary prevention of stroke will lead to a decrease in the incidence and prevalence of stroke, and any therapeutic advance capable of reducing disability will consequently reduce the overall cost of stroke.
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Affiliation(s)
- J-F Spieler
- Service de Neurologie et Centre d'Accueil et de Traitement de l'Attaque Cérébrale, Hôpital Bichat, Université Denis Diderot et Formation de Recherche en Neurologie Vasculaire (Association Claude Bernard), Paris
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Quaglini S, Cavallini A, Gerzeli S, Micieli G. Economic benefit from clinical practice guideline compliance in stroke patient management. Health Policy 2004; 69:305-15. [PMID: 15276310 DOI: 10.1016/j.healthpol.2003.12.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2003] [Accepted: 12/25/2003] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE In a previous study we showed that compliance with evidence-based guidelines improves the health outcome of stroke patients in terms of both survival and residual disability. In this analysis, we shall investigate the impact of such guidelines on healthcare costs during the acute/sub-acute hospitalisation phase. METHOD we considered the direct costs from the hospital's point of view, where funding is provided by the National Healthcare System. We did not consider production loss or intangible costs related to the decreased quality of life. Data was collected on both costs and guideline compliance prospectively, and the relationship between them was studied through a multivariate statistical model. RESULTS Patients treated according to guidelines result in lower costs; on average they have a shorter length of stay in hospital (10.8 versus 12.9 days), leading to a significant difference in the consumption of hospital resources. On a level of statistical analysis, guideline compliance is a significant independent indicator of cost, together with the patient's initial disability and neurological deficit.
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Affiliation(s)
- Silvana Quaglini
- Department of Computer Science and Systems, University of Pavia, Via Ferrata No. 1, 27100 Pavia, Italy.
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Spieler JF, De Pouvourville G, Amarenco P. Cost of a recurrent vs. cost of first-ever stroke over an 18-month period. Eur J Neurol 2003; 10:621-4. [PMID: 14641505 DOI: 10.1046/j.1468-1331.2003.00665.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
When assessing the cost-effectiveness of the secondary prevention of stroke, it is not well known whether the cost of a recurrent brain infarction (BI) is different from a first-ever BI. In a cohort of 435 consecutive prevalent cases of BI (including both recurrent and first-ever BI) we collected medical and socio-economic variables. Handicap was measured with the Rankin scale. Only the direct medical costs were considered over an 18-month period from a societal perspective. We compared first-ever to recurrent BI. Of the 435 patients 20.5% had a recurrent BI. The length of the initial hospitalization and the distribution of the patients into the three classes of handicap (Rankin 0-2, 3, and 4-5) were similar in the first-ever and recurrent BI groups. The average total cost of a first-ever BI was euro 19 725 (95% CI, 17 950-21 501) and euro 18 560 (95% CI, 15 798-21 322) for a recurrent BI (P = 0.48). There were no differences between the two groups when the costs were compared by handicap levels (P = 0.17) or when the costs were compared for each type of expenditure (initial hospitalization, rehabilitation, ambulatory services) except for long-term care, because of the small number of cases. This study suggests that the costs of recurrent BI are roughly similar to the costs of first-ever BI, which may be helpful when studying the cost-effectiveness of secondary stroke prevention trials.
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Affiliation(s)
- J-F Spieler
- Centre of Health Economic and Administration Research (CHEAR), Institut National de la Santé et de la Recherche Médicale (INSERM) U-537, Paris, France
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Ween JE, Shutter LA. Modern stroke unit. Top Stroke Rehabil 2003; 9:1-11. [PMID: 14523713 DOI: 10.1310/cehl-j3gc-yyje-kq2w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The modern stroke unit is making significant contributions to the care of stroke victims and is proving to be an effective, cost-saving enterprise. The precise factors that contribute to the efficacy of these units have yet to be identified, but a combination of protocolized approaches to patient care, critical paths, a focus of expertise, and heightened index of suspicion for comorbidities all probably play a role. This article outlines the basic features of a modern stroke unit and surveys the literature on stroke unit outcomes.
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Affiliation(s)
- Jon Erik Ween
- Stroke Program, Loma Linda University, Casa Colina Centers for Rehabilitation, Loma Linda, California, USA
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Brown P, McArthur C, Newby L, Lay-Yee R, Davis P, Briant R. Cost of medical injury in New Zealand: a retrospective cohort study. J Health Serv Res Policy 2002; 7 Suppl 1:S29-34. [PMID: 12175432 DOI: 10.1258/135581902320176449] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To estimate the cost of treating medical injury associated with hospital admissions in New Zealand and the patient characteristics of costly adverse events. METHODS As part of the New Zealand Quality in Healthcare Study (NZQHS), a retrospective examination of medical records in 13 public hospitals identified the occurrence of clinical procedures and hospital bed days attributable to adverse events. The prices charged to foreign patients were used to estimate the cost of the health care resources used. RESULTS 850 adverse events were identified in the NZQHS which cost an average of $NZ 10,264 per patient. For New Zealand, adverse events are estimated to cost the medical system $NZ 870 million, of which $NZ 590 million went toward treating preventable adverse events. The results suggest that up to 30% of public hospital expenditure goes toward treating an adverse event. The results also suggest that older patients, neonates and those with moderately serious co-morbidity tended to have more costly adverse events. CONCLUSIONS Adverse events lead to a significant use of health care resources in New Zealand. These findings suggest that substantial resources could be saved by eliminating preventable adverse events.
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Affiliation(s)
- Paul Brown
- Department of Community Health, University of Auckland, New Zealand
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