1
|
Reeves MJ, Fonarow GC, Smith EE, Sheth KN, Messe SR, Schwamm LH. Twenty Years of Get With The Guidelines-Stroke: Celebrating Past Successes, Lessons Learned, and Future Challenges. Stroke 2024; 55:1689-1698. [PMID: 38738376 PMCID: PMC11208062 DOI: 10.1161/strokeaha.124.046527] [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: 05/14/2024]
Abstract
The Get With The Guidelines-Stroke program which, began 20 years ago, is one of the largest and most important nationally representative disease registries in the United States. Its importance to the stroke community can be gauged by its sustained growth and widespread dissemination of findings that demonstrate sustained increases in both the quality of care and patient outcomes over time. The objectives of this narrative review are to provide a brief history of Get With The Guidelines-Stroke, summarize its major successes and impact, and highlight lessons learned. Looking to the next 20 years, we discuss potential challenges and opportunities for the program.
Collapse
Affiliation(s)
- Mathew J. Reeves
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing (M.J.R.)
| | - Gregg C. Fonarow
- Division of Cardiology, Geffen School of Medicine, University of California Los Angeles (G.C.F.)
| | - Eric E. Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada (E.E.S.)
| | - Kevin N. Sheth
- Center for Brain & Mind Health, Departments of Neurology & Neurosurgery (K.N.S.), Yale School of Medicine, New Haven, CT
| | - Steven R. Messe
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia (S.R.M.)
| | - Lee H. Schwamm
- Department of Neurology and Bioinformatics and Data Sciences (L.H.S.), Yale School of Medicine, New Haven, CT
| |
Collapse
|
2
|
Hall J, Zhong J, Jowett S, Mazzeo A, Thomas GN, Bryson JR, Dewar S, Inglis N, Wolstencroft M, Muller C, Bloss W, Harrison R, Bartington S. Regional impact assessment of air quality improvement: The air quality lifecourse assessment tool (AQ-LAT) for the West Midlands combined authority (WMCA). ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024:123871. [PMID: 38729507 DOI: 10.1016/j.envpol.2024.123871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 05/12/2024]
Abstract
Poor air quality is the largest environmental health risk in England. In the West Midlands, UK, ∼2.9 million people are affected by air pollution with an average loss in life expectancy of up to 6 months. The 2021 Environment Act established a legal framework for local authorities in England to develop regional air quality plans, generating a policy need for predictive environmental impact assessment tools. In this context, we developed a novel Air Quality Lifecourse Assessment Tool (AQ-LAT) to estimate electoral ward-level impacts of PM2.5 and NO2 exposure on outcomes of interest to local authorities, namely morbidity (asthma, coronary heart disease (CHD), stroke, lung cancer), mortality, and associated healthcare costs. We apply the Tool to assess the health economic burden of air pollutant exposure and estimate benefits that would be generated by meeting WHO 2021 Global Air Quality Guidelines (AQGs) (annual average concentrations) for NO2 (10 μg/m3) and PM2.5 (5 μg/m3) in the West Midlands Combined Authority Area. All West Midlands residents live in areas which exceed WHO AQGs, with 2070 deaths, 2070 asthma diagnoses, 770 CHD diagnoses, 170 lung cancers and 650 strokes attributable to air pollution exposure annually. Reducing PM2.5 and NO2 concentrations to WHO AQGs would save 10,700 lives reducing regional mortality by 1.8%, gaining 92,000 quality-adjusted life years (QALYs), and preventing 20,500 asthma, 7400 CHD, 1400 lung cancer, and 5700 stroke diagnoses, with economic benefits of £3.2 billion over 20 years. Significantly, we estimate 30% of QALY gains relate to reduced disease burden. The AQ-LAT has major potential to be replicated across local authorities in England and applied to inform regional investment decisions.
Collapse
Affiliation(s)
- James Hall
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - Jian Zhong
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK; Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - Sue Jowett
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - Andrea Mazzeo
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK; Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - G Neil Thomas
- Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - John R Bryson
- Department of Strategy and International Business, Birmingham Business School, University of Birmingham, Edgbaston, Birmingham, B152TT, UK
| | - Steve Dewar
- Coventry City Council, Earl Street, Coventry, CV1 5RR, UK
| | - Nadia Inglis
- Coventry City Council, Earl Street, Coventry, CV1 5RR, UK
| | | | - Catherine Muller
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | - William Bloss
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK; Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK
| | | | - Suzanne Bartington
- Institute of Applied Health Research, University of Birmingham, Edgbaston Park Road, Birmingham, B15 2TT, UK.
| |
Collapse
|
3
|
Pinckaers FME, Grutters JPC, Huijberts I, Gabrio A, Boogaarts HD, Postma AA, van Oostenbrugge RJ, van Zwam WH, Evers SMAA. Cost and Utility Estimates per Modified Rankin Scale Score up to 2 Years Post Stroke: Data to Inform Economic Evaluations From a Societal Perspective. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:441-448. [PMID: 38244981 DOI: 10.1016/j.jval.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES Model-based health economic evaluations of ischemic stroke are in need of cost- and utility estimates related to relevant outcome measures. This study aims to describe societal cost- and utility estimates per modified Rankin Scale (mRS)-score at different time points within 2 years post stroke. METHODS Included patients had a stroke between 3 months and 2.5 years ago. mRS and EQ-5D-5L were scored during a telephone interview. Based on the interview date, records were categorized into a time point: 3 months (3M; 3-6 months), 1 year (Y1; 6-18 months), or 2 years (Y2; 18-30 months). Patients completed a questionnaire on healthcare utilization and productivity losses in the previous 3 months. Initial stroke hospitalization costs were assessed. Mean costs and utilities per mRS and time point were derived with multiple imputation nested in bootstrapping. Cost at 3 months post stroke were estimated separately for endovascular treatment (EVT)-/non-EVT-patients. RESULTS 1106 patients were included from 18 Dutch centers. At each time point, higher mRS-scores were associated with increasing average costs and decreasing average utility. Mean societal costs at 3M ranged from €11 943 (mRS 1, no EVT) to €55 957 (mRS 5, no EVT). For Y1, mean costs in the previous 3 months ranged from €885 (mRS 0) to €23 215 (mRS 5), and from €1655 (mRS 0) to €22 904 (mRS 5) for Y2. Mean utilities ranged from 0.07 to 0.96, depending on mRS and time point. CONCLUSIONS The mRS-score is a major determinant of costs and utilities at different post-stroke time points. Our estimates may be used to inform future model-based health economic evaluations.
Collapse
Affiliation(s)
- Florentina M E Pinckaers
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | | | - Ilse Huijberts
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Andrea Gabrio
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | | | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Mental Health and Neuroscience (MHENS), Maastricht University, Maastricht, The Netherlands
| | - Robert J van Oostenbrugge
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands; Department of Neurology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Wim H van Zwam
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands; School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands; Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; Centre of Economic Evaluation and Machine Learning, Trimbos Institute, Utrecht, The Netherlands
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Vyas MV, Fang J, de Oliveira C, Austin PC, Yu AYX, Kapral MK. Attributable Costs of Stroke in Ontario, Canada and Their Variation by Stroke Type and Social Determinants of Health. Stroke 2023; 54:2824-2831. [PMID: 37823307 DOI: 10.1161/strokeaha.123.043369] [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] [Received: 03/26/2023] [Accepted: 07/14/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Estimates of attributable costs of stroke are scarce, as most prior studies do not account for the baseline health care costs in people at risk of stroke. We estimated the attributable costs of stroke in a universal health care setting and their variation across stroke types and several social determinants of health. METHODS We undertook a population-based administrative database-derived matched retrospective cohort study in Ontario, Canada. Community-dwelling adults aged ≥40 years with a stroke between 2003 and 2018 were matched (1:1) on demographics and comorbidities with controls without stroke. Using a difference-in-differences approach, we estimated the mean 1-year direct health care costs attributable to stroke from a public health care payer perspective, accounting for censoring with a weighted available sample estimator. We described health sector-specific costs and reported variation across stroke type and social determinants of health. RESULTS The mean 1-year attributable costs of stroke were Canadian dollars 33 522 (95% CI, $33 231-$33 813), with higher costs for intracerebral hemorrhage ($40 244; $39 193-$41 294) than ischemic stroke ($32 547; $32 252-$32 843). Most of these costs were incurred in acute care hospitals ($15 693) and rehabilitation facilities ($7215). Compared with all patients with stroke, the mean attributable costs were higher among immigrants ($40 554; $39 316-$41 793), those aged <65 years ($35 175; $34 533-$35 818), and those residing in low-income neighborhoods ($34 687; $34 054-$35 320) and lower among rural residents ($29 047; $28 362-$29 731). CONCLUSIONS Our findings of high attributable costs of stroke, especially in immigrants, younger patients, and residents of low-income neighborhoods, can be used to evaluate potential health care cost savings associated with different primary stroke prevention strategies.
Collapse
Affiliation(s)
- Manav V Vyas
- Division of Neurology, Department of Medicine (M.V.V., A.Y.X.Y.), University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- Division of Neurology, Li Ka Shing Knowledge Institute, St. Michael's Hospital-Unity Health Toronto, Canada (M.V.V.)
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Jiming Fang
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Claire de Oliveira
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- Health Economics, Centre for Addictions and Mental Health, Toronto, Canada (C.d.O.)
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Peter C Austin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| | - Amy Y X Yu
- Division of Neurology, Department of Medicine (M.V.V., A.Y.X.Y.), University of Toronto, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada (A.Y.X.Y.)
| | - Moira K Kapral
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health (M.V.V., C.d.O., P.C.A., A.Y.X.Y., M.K.K.), University of Toronto, Canada
- Division of General Internal Medicine, Department of Medicine (M.K.K.), University of Toronto, Canada
- ICES, Toronto, Canada (M.V.V., J.F., C.d.O., P.C.A., A.Y.X.Y., M.K.K.)
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
van Mastrigt G, van Heugten C, Visser-Meily A, Bremmers L, Evers S. Estimating the Burden of Stroke: Two-Year Societal Costs and Generic Health-Related Quality of Life of the Restore4Stroke Cohort. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191711110. [PMID: 36078828 PMCID: PMC9517815 DOI: 10.3390/ijerph191711110] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
(1) Background: This study aimed to investigate two-year societal costs and generic health-related quality of life (QoL) using a bottom-up approach for the Restore4Stroke Cohort. (2) Methods: Adult post-stroke patients were recruited from stroke units throughout the Netherlands. The societal costs were calculated for healthcare and non-healthcare costs in the first two years after stroke. The QoL was measured using EQ-5D-3L. The differences between (sub)groups over time were investigated using a non-parametric bootstrapping method. (3) Results: A total of 344 post-stroke patients were included. The total two-year societal costs of a post-stroke were EUR 47,502 (standard deviation (SD = EUR 2628)). The healthcare costs decreased by two thirds in the second year -EUR 14,277 (95% confidence interval -EUR 17,319, -EUR 11,236). In the second year, over 50% of the total societal costs were connected to non-healthcare costs (such as informal care, paid help, and the inability to perform unpaid labor). Sensitivity analyses confirmed the importance of including non-healthcare costs for long-term follow-up. The subgroup analyses showed that patients who did not return home after discharge, and those with moderate to severe stroke symptoms, incurred significantly more costs compared to patients who went directly home and those who reported fewer symptoms. QoL was stable over time except for the stroke patients over 75 years of age, where a significant and clinically meaningful decrease in QoL over time was observed. (4) Conclusions: The non-healthcare costs have a substantial impact on the first- and second-year total societal costs post-stroke. Therefore, to obtain a complete picture of all the relevant costs related to a stroke, a societal perspective with a follow-up of at least two years is highly recommended. Additionally, more research is needed to investigate the decline in QoL found in stroke patients above the age of 75 years.
Collapse
Affiliation(s)
- Ghislaine van Mastrigt
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Correspondence:
| | - Caroline van Heugten
- MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands
- Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Anne Visser-Meily
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Leonarda Bremmers
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University, 3062 PA Rotterdam, The Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction Utrecht, 3521 VS Utrechtcity, The Netherlands
| |
Collapse
|
8
|
Kortelainen S, Curtze S, Martinez‐Majander N, Raj R, Skrifvars MB. Acute ischemic stroke in a university hospital intensive care unit: 1-year costs and outcome. Acta Anaesthesiol Scand 2022; 66:516-525. [PMID: 35118640 PMCID: PMC9304289 DOI: 10.1111/aas.14037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/05/2021] [Accepted: 01/08/2022] [Indexed: 11/29/2022]
Abstract
Background and purpose Little is currently known about the cost‐effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1‐year costs and outcome for patients with AIS treated in the intensive care unit (ICU). Materials and methods A single‐center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019. Patient outcome was 12‐month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO). Results The study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%). There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome. High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91–0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87–0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97–0.99) per added year. The ECPS and ECPFO were 115,628€ and 291,210€, respectively. Conclusions Treatment of AIS in the ICU is resource‐intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost‐efficacy of ICU care for AIS patients.
Collapse
Affiliation(s)
- Simon Kortelainen
- Department of Emergency Care and Services University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Sami Curtze
- Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland
| | | | - Rahul Raj
- Department of Neurosurgery University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Markus B. Skrifvars
- Department of Emergency Care and Services University of Helsinki and Helsinki University Hospital Helsinki Finland
| |
Collapse
|
9
|
Menut KCH, Pearlstein SS, Conroy PC, Roman SA, Shen WT, Gosnell J, Sosa JA, Duh QY, Suh I. Screening for primary aldosteronism in the hypertensive obstructive sleep apnea population is cost-saving. Surgery 2022; 171:96-103. [PMID: 34238603 PMCID: PMC9308489 DOI: 10.1016/j.surg.2021.05.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/08/2021] [Accepted: 05/04/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Guidelines recommend screening for primary aldosteronism in patients diagnosed with hypertension and obstructive sleep apnea. Recent studies have shown that adherence to these recommendations is extremely low. It has been suggested that cost is a barrier to implementation. No analysis has been done to rigorously evaluate the cost-effectiveness of widespread implementation of these guidelines. METHODS We constructed a decision-analytic model to evaluate screening of the hypertensive obstructive sleep apnea population for primary aldosteronism as per guideline recommendations in comparison with current rates of screening. Probabilities, utility values, and costs were identified in the literature. Threshold and sensitivity analyses assessed robustness of the model. Costs were represented in 2020 US dollars and health outcomes in quality-adjusted life-years. The model assumed a societal perspective with a lifetime time horizon. RESULTS Screening per guideline recommendations had an expected cost of $47,016 and 35.27 quality-adjusted life-years. Continuing at current rates of screening had an expected cost of $48,350 and 34.86 quality-adjusted life-years. Screening was dominant, as it was both less costly and more effective. These results were robust to sensitivity analysis of disease prevalence, test sensitivity, patient age, and expected outcome of medical or surgical treatment of primary aldosteronism. The screening strategy remained cost-effective even if screening were conservatively presumed to identify only 3% of new primary aldosteronism cases. CONCLUSIONS For patients with hypertension and obstructive sleep apnea, rigorous screening for primary aldosteronism is cost-saving due to cardiovascular risk averted. Cost should not be a barrier to improving primary aldosteronism screening adherence.
Collapse
Affiliation(s)
| | | | - Patricia C. Conroy
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Sanziana A. Roman
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Wen T. Shen
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Jessica Gosnell
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Julie Ann Sosa
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Quan-Yang Duh
- Section of Endocrine Surgery, University of California, San Francisco, CA
| | - Insoo Suh
- Division of Endocrine Surgery, New York University Langone Health, New York, NY,Reprint requests: Insoo Suh, MD, NYU Endocrine Surgery Associates, 530 1st Ave, Ste 6H New York, NY 10016. (I. Suh)
| |
Collapse
|
10
|
Yu AYX, Smith EE, Krahn M, Austin PC, Rashid M, Fang J, Porter J, Vyas MV, Bronskill SE, Swartz RH, Kapral MK. Association of Neighborhood-Level Material Deprivation With Health Care Costs and Outcome After Stroke. Neurology 2021; 97:e1503-e1511. [PMID: 34408072 PMCID: PMC8575135 DOI: 10.1212/wnl.0000000000012676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the association between material deprivation and direct health care costs and clinical outcomes following stroke in the context of a publicly funded universal health care system. METHODS In this population-based cohort study of patients with ischemic and hemorrhagic stroke admitted to the hospital between 2008 and 2017 in Ontario, Canada, we used linked administrative data to identify the cohort, predictor variables, and outcomes. The exposure was a 5-level neighborhood material deprivation index. The primary outcome was direct health care costs incurred by the public payer in the first year. Secondary outcomes were death and admission to long-term care. RESULTS Among 90,289 patients with stroke, the mean (SD) per-person costs increased with increasing material deprivation, from $50,602 ($55,582) in the least deprived quintile to $56,292 ($59,721) in the most deprived quintile (unadjusted relative cost ratio and 95% confidence interval 1.11 [1.08, 1.13] and adjusted relative cost ratio 1.07 [1.05, 1.10] for least compared to most deprived quintile). People in the most deprived quintile had higher mortality within 1 year compared to the least deprived quintile (adjusted hazard ratio [HR] 1.07 [1.03, 1.12]) as well as within 3 years (adjusted HR 1.09 [1.05, 1.13]). Admission to long-term care increased incrementally with material deprivation and those in the most deprived quintile had an adjusted HR of 1.33 (1.24, 1.43) compared to those in the least deprived quintile. DISCUSSION Material deprivation is a risk factor for increased costs and poor outcomes after stroke. Interventions targeting health inequities due to social determinants of health are needed. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the neighborhood-level material deprivation predicts direct health care costs.
Collapse
Affiliation(s)
- Amy Y X Yu
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada.
| | - Eric E Smith
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Murray Krahn
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Peter C Austin
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Mohammed Rashid
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Jiming Fang
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Joan Porter
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Manav V Vyas
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Susan E Bronskill
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Richard H Swartz
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Moira K Kapral
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| |
Collapse
|
11
|
Ribera A, Vela E, García-Altés A, Clèries M, Abilleira S. Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:21-30. [PMID: 34538775 DOI: 10.1016/j.nrleng.2018.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/17/2018] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Despite improved survival rates, stroke represents an increasing healthcare and socioeconomic burden. We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke, using a population-based dataset. METHODS The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016. For each patient, information from one year before the stroke and up to 3 years thereafter was linked across databases. We describe annual and monthly resource use and healthcare expenditure per patient. RESULTS We identified 36 044 patients with ischaemic stroke (mean age, 74.7 ± 13.3 years). The survival rate at 3 years was 63%. Average expenditure per patient was €3230 the year before stroke, €11 060 for year 1 after stroke, €4104 for year 2, and €3878 for year 3. The greatest determinants of cost in year 1 were hospitalisation (including initial hospitalisation), representing 45% of the difference in expenditure compared to the previous year, and convalescence and rehabilitation services, representing 33% of this difference. After year one, the increase in expenditure was mainly determined by additional hospital admissions and drug treatment. CONCLUSION After ischaemic stroke, healthcare expenditure increases primarily because of initial hospitalisation. After year one, the expenditure decreases but remains above baseline values. Information from population-based datasets is useful for improving the planning of stroke services.
Collapse
Affiliation(s)
- A Ribera
- Unidad de Epidemiología Cardiovascular, Hospital Universitario Vall d'Hebron, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain.
| | - E Vela
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - A García-Altés
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - M Clèries
- Unitat d'Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
| | - S Abilleira
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain; Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain; Agència per la Qualitat i l'Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain
| |
Collapse
|
12
|
Zígolo MA, Goytia MR, Poma HR, Rajal VB, Irazusta VP. Virtual screening of plant-derived compounds against SARS-CoV-2 viral proteins using computational tools. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 781:146400. [PMID: 33794459 PMCID: PMC7967396 DOI: 10.1016/j.scitotenv.2021.146400] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/18/2021] [Accepted: 03/05/2021] [Indexed: 05/08/2023]
Abstract
The new SARS-CoV-2, responsible for the COVID-19 pandemic, has been threatening public health worldwide for more than a year. The aim of this work was to evaluate compounds of natural origin, mainly from medicinal plants, as potential SARS-CoV-2 inhibitors through docking studies. The viral spike (S) glycoprotein and the main protease Mpro, involved in the recognition of virus by host cells and in viral replication, respectively, were the main molecular targets in this study. Molecular docking was performed using AutoDock, which allowed us to select the plant actives with the highest affinity towards the viral targets and to identify the interaction molecular sites with the SARS-CoV2 proteins. The best energy binding values for S protein were, in kcal/mol: -19.22 for glycyrrhizin, -17.84 for gitoxin, -12.05 for dicumarol, -10.75 for diosgenin, and -8.12 for delphinidin. For Mpro were, in kcal/mol: -9.36 for spirostan, -8.75 for N-(3-acetylglycyrrhetinoyl)-2-amino-propanol, -8.41 for α-amyrin, -8.35 for oleanane, -8.11 for taraxasterol, and -8.03 for glycyrrhetinic acid. In addition, the synthetic drugs umifenovir, chloroquine, and hydroxychloroquine were used as controls for S protein, while atazanavir and nelfinavir were used for Mpro. Key hydrogen bonds and hydrophobic interactions between natural compounds and the respective viral proteins were identified, allowing us to explain the great affinity obtained in those compounds with the lowest binding energies. These results suggest that these natural compounds could potentially be useful as drugs to be experimentally evaluated against COVID-19.
Collapse
Affiliation(s)
- María Antonela Zígolo
- Instituto de Investigaciones para la Industria Química (INIQUI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Universidad Nacional de Salta (UNSa), Av. Bolivia 5150, 4400 Salta, Argentina; Facultad de Ciencias Naturales, UNSa, Salta, Argentina
| | - Matías Rivero Goytia
- Silentium Apps, Salta, Argentina; Facultad de Economía y Administración, Universidad Católica de Salta (UCASAL), Salta, Argentina
| | - Hugo Ramiro Poma
- Instituto de Investigaciones para la Industria Química (INIQUI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Universidad Nacional de Salta (UNSa), Av. Bolivia 5150, 4400 Salta, Argentina
| | - Verónica Beatriz Rajal
- Instituto de Investigaciones para la Industria Química (INIQUI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Universidad Nacional de Salta (UNSa), Av. Bolivia 5150, 4400 Salta, Argentina; Facultad de Ingeniería, UNSa, Salta, Argentina; Singapore Centre for Environmental Life Sciences Engineering (SCELSE), Nanyang Technological University, Singapore, Singapore.
| | - Verónica Patricia Irazusta
- Instituto de Investigaciones para la Industria Química (INIQUI), Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) - Universidad Nacional de Salta (UNSa), Av. Bolivia 5150, 4400 Salta, Argentina; Facultad de Ciencias Naturales, UNSa, Salta, Argentina
| |
Collapse
|
13
|
Yu AYX, Krahn M, Austin PC, Rashid M, Fang J, Porter J, Vyas MV, Bronskill SE, Smith EE, Swartz RH, Kapral MK. Sex differences in direct healthcare costs following stroke: a population-based cohort study. BMC Health Serv Res 2021; 21:619. [PMID: 34187462 PMCID: PMC8240191 DOI: 10.1186/s12913-021-06669-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke. METHODS In this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs. RESULTS We identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65-84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496-$72,227] for women versus $32,903 [$15,485-$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care. CONCLUSIONS Patterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings.
Collapse
Affiliation(s)
- Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada.
- ICES, Toronto, Ontario, Canada.
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
| | - Murray Krahn
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (General Internal Medicine), University of Toronto-University Health Network, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Manav V Vyas
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan E Bronskill
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Richard H Swartz
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Moira K Kapral
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine (General Internal Medicine), University of Toronto-University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
14
|
de Berker H, de Berker A, Aung H, Duarte P, Mohammed S, Shetty H, Hughes T. Pre-stroke disability and stroke severity as predictors of discharge destination from an acute stroke ward. Clin Med (Lond) 2021; 21:e186-e191. [PMID: 33762385 DOI: 10.7861/clinmed.2020-0834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND RATIONALE Reliable prediction of discharge destination in acute stroke informs discharge planning and can determine the expectations of patients and carers. There is no existing model that does this using routinely collected indices of pre-morbid disability and stroke severity. METHODS Age, gender, pre-morbid modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) were gathered prospectively on an acute stroke unit from 1,142 consecutive patients. A multiclass random forest classifier was used to train and validate a model to predict discharge destination. RESULTS Used alone, the mRS is the strongest predictor of discharge destination. The NIHSS is only predictive when combined with our other variables. The accuracy of the final model was 70.4% overall with a positive predictive value (PPV) and sensitivity of 0.88 and 0.78 for home as the destination, 0.68 and 0.88 for continued inpatient care, 0.7 and 0.53 for community hospital, and 0.5 and 0.18 for death, respectively. CONCLUSION Pre-stroke disability rather than stroke severity is the strongest predictor of discharge destination, but in combination with other routinely collected data, both can be used as an adjunct by the multidisciplinary team to predict discharge destination in patients with acute stroke.
Collapse
Affiliation(s)
- Henry de Berker
- Royal Manchester Children's Hospital, Manchester, UK .,joint first authors
| | | | - Htin Aung
- Royal Glamorgan Hospital, Llantrisant, UK
| | | | | | | | | |
Collapse
|
15
|
Willers C, Westerlind E, Borgström F, von Euler M, Sunnerhagen KS. Health insurance utilisation after ischaemic stroke in Sweden: a retrospective cohort study in a system of universal healthcare and social insurance. BMJ Open 2021; 11:e043826. [PMID: 33762236 PMCID: PMC7993163 DOI: 10.1136/bmjopen-2020-043826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stroke is one of the largest single-condition sources of the global burden of non-communicable disease in terms of disability-adjusted life-years and monetary costs, directly as well as indirectly in terms of informal care and productivity loss. The objective was to assess the population afflicted with ischaemic stroke in working age in the context of universal healthcare and social insurance; to estimate the levels of absence from work, the indirect costs related to that and to assess the associated patient characteristics. METHODS This was a retrospective register-based study; all individuals registered with an ischaemic stroke during 2008-2011 in seven Swedish regions, covering the largest cities as well as more rural areas, were included. Individual-level data were used to compute net days of sick leave and disability pension, indirect costs due to productivity loss and to perform regression analysis on net absence from work to assess the associated factors. Costs related to productivity loss were estimated using the human capital approach. RESULTS Women had significantly fewer net days of sick leave and disability pension than men after multivariable adjustment, and high-income groups had higher levels of sick leave than low-income groups. There were no significant differences for participants regarding educational level, region of birth or civil status. Indirect monetary costs amounted to €17 400 per stroke case during the first year, totalling approximately €169 million in Sweden. CONCLUSION The individual's burden of stroke is heavy in terms of morbidity, and the related productivity loss for society is immense. Income-group differences point to a socioeconomic gradient in the utilisation of the Swedish social insurance.
Collapse
Affiliation(s)
- Carl Willers
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Emma Westerlind
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Goteborg, Sweden
| | - Fredrik Borgström
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institute, Stockholm, Sweden
- Quantify Research, Stockholm, Sweden
| | - Mia von Euler
- School of Medicine, Örebro university, Örebro, Sweden
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Goteborg, Sweden
| |
Collapse
|
16
|
Seppelt PC, Mas-Peiro S, De Rosa R, Dimitriasis Z, Zeiher AM, Vasa-Nicotera M. Thirty-day incidence of stroke after transfemoral transcatheter aortic valve implantation: meta-analysis and mixt-treatment comparison of self-expandable versus balloon-expandable valve prostheses. Clin Res Cardiol 2020; 110:640-648. [PMID: 33249517 PMCID: PMC8099765 DOI: 10.1007/s00392-020-01775-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/28/2020] [Indexed: 11/28/2022]
Abstract
Aims Stroke is a major complication after transcatheter aortic valve implantation (TAVI). Although multifactorial, it remains unknown whether the valve deployment system itself has an impact on the incidence of early stroke. We performed a meta- and network analysis to investigate the 30-day stroke incidence of self-expandable (SEV) and balloon-expandable (BEV) valves after transfemoral TAVI. Methods and results Overall, 2723 articles were searched directly comparing the performance of SEV and BEV after transfemoral TAVI, from which 9 were included (3086 patients). Random effects models were used for meta- and network meta-analysis based on a frequentist framework. Thirty-day incidence of stroke was 1.8% in SEV and 3.1% in BEV (risk ratio of 0.62, 95% confidence interval (CI) 0.49–0.80, p = 0.004). Treatment ranking based on network analysis (P-score) revealed CoreValve with the best performance for 30-day stroke incidence (75.2%), whereas SAPIEN had the worst (19.0%). However, network analysis showed no inferiority of SAPIEN compared with CoreValve (odds ratio 2.24, 95% CI 0.70–7.2). Conclusion Our analysis indicates higher 30-day stroke incidence after transfemoral TAVI with BEV compared to SEV. We could not find evidence for superiority of a specific valve system. More randomized controlled trials with head-to-head comparison of SEV and BEV are needed to address this open question. Graphic abstract ![]()
Collapse
Affiliation(s)
- Philipp C Seppelt
- Division of Cardiology, Department of Medicine III, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany. .,DZHK partner site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany.
| | - Silvia Mas-Peiro
- Division of Cardiology, Department of Medicine III, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.,DZHK partner site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Roberta De Rosa
- Division of Cardiology, Department of Medicine III, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Zisis Dimitriasis
- Division of Cardiology, Department of Medicine III, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.,DZHK partner site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Andreas M Zeiher
- Division of Cardiology, Department of Medicine III, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.,DZHK partner site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| | - Mariuca Vasa-Nicotera
- Division of Cardiology, Department of Medicine III, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany.,DZHK partner site Rhine-Main, German Centre for Cardiovascular Research, Berlin, Germany
| |
Collapse
|
17
|
Minet LR, Peterson E, von Koch L, Ytterberg C. Healthcare Utilization After Stroke: A 1-Year Prospective Study. J Am Med Dir Assoc 2020; 21:1684-1688. [DOI: 10.1016/j.jamda.2020.04.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/25/2020] [Accepted: 04/28/2020] [Indexed: 11/15/2022]
|
18
|
Yousufuddin M, Moriarty JP, Lackore KA, Zhu Y, Peters JL, Doyle T, Jensen KL, Ahmmad EM, Al Ward RY, Al-Zu'bi HM, Sharma UM, Seshadri A, Arumaithurai K, Keenan LR, Bhagra S, Murad MH, Borah BJ. Initial and subsequent 3-year cost after hospitalization for first acute ischemic stroke and intracerebral hemorrhage. J Neurol Sci 2020; 419:117181. [PMID: 33099173 DOI: 10.1016/j.jns.2020.117181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/26/2020] [Accepted: 10/10/2020] [Indexed: 11/25/2022]
Abstract
AIMS To examine 1) the major drivers of index hospitalization and 3-year post-acute follow-up care, 2) cost for rehabilitation and homecare, and 3) indirect cost from lost productivity after acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). METHODS Retrospective study of adults hospitalized with AIS (n = 811) and ICH (N = 145) between 2003 and 2014. Direct costs standardized to Medicare reimbursement rates were captured for hospitalization and 3-year follow-up or death. Adjusted cost estimates were assessed using generalized linear modeling with gamma distribution. Costs for rehabilitation, home healthcare, and lost productivity were assessed using sets of cost captured through literature review. RESULTS Calculated as mean cost per person: hospitalization $18,154 for AIS and $24,077 for ICH; monthly 3-year aggregate $5138 for AIS and $8172 for ICH; 3-year inpatient rehabilitation $4185 for AIS and $4196 for ICH; homecare $19,728 for AIS and $14,487 for ICH; indirect cost from lost productivity $77,078 for AIS and $56,601 for ICH. Age < 55 years, being non-white, and stroke severity were strongly associated with greater hospitalization cost for AIS and ICH. Hyperlipidemia incurred lower while cancer, coronary artery disease, asthma/chronic obstructive pulmonary disease, heart failure, and anemia incurred higher 3-year aggregate cost for AIS. Cancer and diabetes mellitus incurred higher 3-year aggregate cost for ICH. CONCLUSIONS We provide estimates of direct and indirect costs incurred for acute and continuing post-acute care through a 3-year follow-up period after first-ever AIS and ICH with important comparisons for predictors between index hospitalization and 3-year post-stroke costs.
Collapse
Affiliation(s)
- Mohammed Yousufuddin
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
| | - James P Moriarty
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Kandace A Lackore
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Ye Zhu
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Jessica L Peters
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Taylor Doyle
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Kelsey L Jensen
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Eimad M Ahmmad
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Ruaa Y Al Ward
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Hossam M Al-Zu'bi
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Umesh M Sharma
- Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | - Ashok Seshadri
- Department of Psychiatry and Psychology, Mayo Clinic Health System, Austin, MN, USA
| | | | - Lawrence R Keenan
- Department of Cardiology, Mayo Clinic Health System, Austin, MN, USA
| | - Sumit Bhagra
- Department of Endocrinology, Mayo Clinic Health System, Austin, MN, USA
| | - Mohammad Hassan Murad
- Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA; Department of Preventive Medicine, Mayo Clinic, Rochester, United States of America
| | - Bijan J Borah
- Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
19
|
Forné C, Subirana I, Blanch J, Ferrieres J, Azevedo A, Meisinger C, Farmakis D, Tavazzi L, Davoli M, Ramos R, Brosa M, Marrugat J, Dégano IR. A cost-utility analysis of increasing percutaneous coronary intervention use in elderly patients with acute coronary syndromes in six European countries. Eur J Prev Cardiol 2020; 28:408-417. [PMID: 33966078 DOI: 10.1177/2047487320942644] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/25/2020] [Indexed: 01/08/2023]
Abstract
AIMS Percutaneous coronary intervention reduces mortality in acute coronary syndrome patients but the cost-utility of increasing its use in elderly acute coronary syndrome patients is unknown. METHODS We assessed the efficiency of increased percutaneous coronary intervention use compared to current practice in patients aged ≥75 years admitted for acute coronary syndrome in France, Germany, Greece, Italy, Portugal and Spain with a semi-Markov state transition model. In-hospital mortality reduction estimates by percutaneous coronary intervention use and costs were derived from the EUROpean Treatment & Reduction of Acute Coronary Syndromes cost analysis EU project (n = 28,600). Risk of recurrence and out-of-hospital all-cause mortality were obtained from the Information System for the Development of Research in Primary Care (SIDIAP) database from North-Eastern Spain (n = 55,564). In-hospital mortality was modelled using stratified propensity score analysis. The 8-year acute coronary syndrome recurrence risk and out-of-hospital mortality were estimated with a multistate survival model. The scenarios analysed were to increase percutaneous coronary intervention use among patients with the highest, moderate and lowest probability of receiving percutaneous coronary intervention based on the propensity score analysis. RESULTS France, Greece and Portugal showed similar total costs/1000 individuals (7.29-11.05 m €); while in Germany, Italy and Spain, costs were higher (13.53-22.57 m €). Incremental cost-utility ratios of providing percutaneous coronary intervention to all patients ranged from 2262.8 €/quality adjusted life year gained for German males to 6324.3 €/quality adjusted life year gained for Italian females. Increasing percutaneous coronary intervention use was cost-effective at a willingness-to-pay threshold of 10,000 €/quality adjusted life year gained for all scenarios in the six countries, in males and females. CONCLUSION Compared to current clinical practice, broadening percutaneous coronary intervention use in elderly acute coronary syndrome patients would be cost-effective across different healthcare systems in Europe, regardless of the selected strategy.
Collapse
Affiliation(s)
- C Forné
- Department of Basic Medical Sciences, University of Lleida, Spain
| | - I Subirana
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Spain.,CIBER Epidemiology and Public Health, Instituto de Salud Carlos III (ISCIII), Spain
| | - J Blanch
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Spain
| | - J Ferrieres
- Department of Cardiology, Toulouse University School of Medicine, France
| | - A Azevedo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Portugal
| | - C Meisinger
- MONICA/KORA Myocardial Infarction Registry, University Hospital of Augsburg, Germany.,Helmholtz Zentrum München, German Research Center for Environmental Health, Germany
| | - D Farmakis
- University of Cyprus Medical School, Cyprus.,Second Department of Cardiology, University of Athens Medical School, Greece
| | - L Tavazzi
- Maria Cecilia Hospital, GVM Care and Research, Italy
| | - M Davoli
- Department of Epidemiology, Lazio Regional Health Service, Italy
| | - R Ramos
- Vascular Health Research Group (ISV-Girona), Jordi Gol Institute for Primary Care Research (IDIAPJGol), Spain.,Catalan Institute of Health, Spain.,Department of Medical Sciences, University of Girona, Spain.,Girona Biomedical Research Institute (IdIBGi), Spain
| | - M Brosa
- Oblikue Consulting SL, Spain
| | - J Marrugat
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Spain.,Centro de Investigación Biomédica en Red (CIBER) of Cardiovascular Diseases, ISCIII, Spain
| | - I R Dégano
- REGICOR Study Group, IMIM (Hospital del Mar Medical Research Institute), Spain.,Centro de Investigación Biomédica en Red (CIBER) of Cardiovascular Diseases, ISCIII, Spain.,Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Spain
| | | |
Collapse
|
20
|
Luengo-Fernandez R, Violato M, Candio P, Leal J. Economic burden of stroke across Europe: A population-based cost analysis. Eur Stroke J 2020; 5:17-25. [PMID: 32232166 PMCID: PMC7092742 DOI: 10.1177/2396987319883160] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION In 2017, 1.5 million people were diagnosed with stroke, 9 million were living with stroke and 0.4 million died because of stroke in 32 European countries. We estimate the economic burden of stroke across these countries in 2017. PATIENTS AND METHODS In a population-based cost analysis, we evaluated the cost of stroke. We estimated overall health and social care costs from expenditure on care in the primary, outpatient, emergency, inpatient and nursing/residential care settings, and pharmaceuticals. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients, lost earnings due to premature death and costs associated with individuals who temporarily or permanently left employment because of illness. RESULTS In 2017 stroke cost the 32 European countries under analysis €60 billion, with health care accounting for €27 billion (45%), representing 1.7% of health expenditure. Adding the costs of social care (€5 billion), annual stroke-related care costs were equivalent to €59 per citizen, varying from €11 in Bulgaria to €140 in Finland. Productivity losses cost €12 billion, equally split between early death and lost working days. A total of €1.3 billion hours of informal care were provided to stroke survivors, costing Europe €16 billion. CONCLUSION Our study provides a snapshot of the economic consequences posed by stroke to 32 European countries in 2017. It also strengthens and updates the evidence we have gathered over the last 15 years, indicating that the costs of stroke are rising, partly due to an ageing population.
Collapse
Affiliation(s)
- Ramon Luengo-Fernandez
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mara Violato
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Paolo Candio
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jose Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
21
|
Kim SE, Lee H, Kim JY, Lee KJ, Kang J, Kim BJ, Han MK, Choi KH, Kim JT, Shin DI, Yeo MJ, Cha JK, Kim DH, Nah HW, Kim DE, Ryu WS, Park JM, Kang K, Kim JG, Lee SJ, Oh MS, Yu KH, Lee BC, Park HK, Hong KS, Cho YJ, Choi JC, Sohn SI, Hong JH, Park MS, Park TH, Park SS, Lee KB, Kwon JH, Kim WJ, Lee J, Lee JS, Lee J, Meretoja A, Gorelick PB, Bae HJ. Three-month modified Rankin Scale as a determinant of 5-year cumulative costs after ischemic stroke. Neurology 2020; 94:e978-e991. [DOI: 10.1212/wnl.0000000000009034] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 09/24/2019] [Indexed: 02/04/2023] Open
Abstract
ObjectiveStroke is a devastating and costly disease; however, there is a paucity of information on long-term costs and on how they differ according to 3-month modified Rankin scale (mRS) score, which is a primary outcome variable in acute stroke intervention trials.MethodsWe analyzed a prospective multicenter stroke registry (Clinical Research Collaboration for Stroke in Korea) database through linkage with claims data from the National Health Insurance Service with follow-up to December 2016. Healthcare expenditures were converted into daily cost individually, and annual and cumulative costs up to 5 years were estimated and compared according to the 3-month mRS score.ResultsBetween January 2011 and November 2013, 11,136 patients were enrolled in the study. The mean age was 68 years, and 58% were men. The median follow-up period was 3.9 years (range 0–5 years). Mean cumulative cost over 5 years was $117,576 (US dollars [USD]); the cost in the first year after stroke was the highest ($38,152 USD), which increased markedly from the cost a year before stroke ($8,718 USD). The mean 5-year cumulative costs differed significantly according to the 3-month mRS score (p < 0.001); the costs for a 3-month mRS score of 0 or 5 were $53,578 and $257,486 USD, respectively. Three-month mRS score was an independent determinant of long-term costs after stroke.ConclusionsWe show that 3-month mRS score plays an important role in the prediction of long-term costs after stroke. Such estimates relating to 3-month mRS categories may be valuable when undertaking health economic evaluations related to stroke care.
Collapse
|
22
|
Health Care Costs and Savings Associated with Increased Dairy Consumption among Adults in the United States. Nutrients 2020; 12:nu12010233. [PMID: 31963237 PMCID: PMC7019333 DOI: 10.3390/nu12010233] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/02/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study is to estimate the impact on health care costs if United States (US) adults increased their dairy consumption to meet Dietary Guidelines for Americans (DGA) recommendations. METHODS Risk estimates from recent meta-analyses quantifying the association between dairy consumption and health outcomes were combined with the increase in dairy consumption under two scenarios where population mean dairy intakes from the 2015-2016 What We Eat in America were increased to meet the DGA recommendations: (1) according to proportions by type as specified in US Department of Agriculture Food Intake Patterns and (2) assuming the consumption of a single dairy type. The resulting change in risk was combined with published data on annual health care costs to estimate impact on costs. Health care costs were adjusted to account for potential double counting due to overlapping comorbidities of the health outcomes included. RESULTS Total dairy consumption among adults in the US was 1.49 cup-equivalents per day (c-eq/day), requiring an increase of 1.51 c-eq/day to meet the DGA recommendation. Annual cost savings of $12.5 billion (B) (range of $2.0B to $25.6B) were estimated based on total dairy consumption resulting from a reduction in stroke, hypertension, type 2 diabetes, and colorectal cancer and an increased risk of Parkinson's disease and prostate cancer. Similar annual cost savings were estimated for an increase in low-fat dairy consumption ($14.1B; range of $0.8B to $27.9B). Among dairy sub-types, an increase of approximately 0.5 c-eq/day of yogurt consumption alone to help meet the DGA recommendations resulted in the highest annual cost savings of $32.5B (range of $16.5B to $52.8B), mostly driven by a reduction in type 2 diabetes. CONCLUSIONS Adoption of a dietary pattern with increased dairy consumption among adults in the US to meet DGA recommendations has the potential to provide billions of dollars in savings.
Collapse
|
23
|
Beyhaghi H, Viera AJ. Comparative Cost-Effectiveness of Clinic, Home, or Ambulatory Blood Pressure Measurement for Hypertension Diagnosis in US Adults. Hypertension 2019; 73:121-131. [PMID: 30571548 DOI: 10.1161/hypertensionaha.118.11715] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Previous cost-effectiveness models found ambulatory blood pressure monitoring (ABPM) to be a favorable strategy to diagnose hypertension; however, they mostly focused on older adults with a positive clinic blood pressure (BP) screen. We evaluated the cost-effectiveness of 3 methods of BP measurement for hypertension diagnosis in primary care settings among 14 age- and sex-stratified hypothetical cohorts (adults ≥21 years of age), accounting for the possibility of both false-positive (white-coat hypertension) and false-negative (masked hypertension) clinic measurements. We compared quality-adjusted life-years and lifetime costs ($US 2017 from the US healthcare perspective) associated with clinic BP measurement, home BP monitoring, and ABPM under 2 scenarios: positive and negative initial screen. Model parameters were obtained from published literature, publicly available data sources, and expert input. In the screen-positive scenario, ABPM was the dominant strategy among all age and sex groups. Compared with clinic BP measurement, ABPM was associated with cost-savings ranging from $77 (women 80 years of age) to $5013 (women 21 years of age). In the screen-negative scenario, ABPM was the dominant strategy in all men and women <80 years of age with cost-savings ranging from $128 (women 70 years of age) to $2794 (women 21 years of age). Sensitivity analyses showed that results were sensitive to test specificity and antihypertensive medication costs. ABPM is recommended as the diagnostic strategy of choice for most adults in primary care settings regardless of initial screening results.
Collapse
Affiliation(s)
- Hadi Beyhaghi
- From the Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill (H.B.)
| | - Anthony J Viera
- Department of Community and Family Medicine, Duke University, NC (A.J.V.)
| |
Collapse
|
24
|
Smith L, Atherly A, Campbell J, Flattery N, Coronel S, Krantz M. Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk. BMC Public Health 2019; 19:1234. [PMID: 31492118 PMCID: PMC6728976 DOI: 10.1186/s12889-019-7573-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 08/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) risk-reduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. This program has previously demonstrated success, but the cost-effectiveness is unknown. CHW-based interventions are potentially attractive complements to healthcare delivery because laypersons implement the intervention at a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources. METHODS CHWs performed screenings and provided ongoing participant support within predominantly rural communities. A point-of-service software tool was used to generate 10-year Framingham CVD risk scores and assist CHWs to make medical referrals and provide ongoing individualized support for lifestyle changes. A sample of program participants returned for reassessment of risk factors. We calculated quality-adjusted life years (QALYs) gained and program costs using a Markov model. Transition probabilities were calculated using Framingham risk equations or derived from the literature using the observed mean reduction in 10-year CVD risk score over of 37- months follow-up. Program cost-effectiveness was calculated for both at-risk (abnormal baseline CVD risk factors) and overall program populations. RESULTS The base-case scenario evaluating a 52-year-old male participant revealed an incremental cost savings of $3576 and a gain of 0.16 QALYs associated with the intervention. Cost savings were greater in at-risk populations. The economic dominance of the model was robust in multiple sensitivity analyses. CONCLUSIONS A community-based CVD intervention demonstrated to reduce CVD risk is cost-effective. This suggests that population-based public health programs may have the potential to complement primary care preventative services to improve health and reduce the burden of traditional medical care.
Collapse
Affiliation(s)
- Lauren Smith
- School of Public Health, University of Colorado, Aurora, USA
| | - Adam Atherly
- Center for Health Services Research, Larner College of Medicine, University of Vermont, 89 Beaumont Ave, Burlington, VT, 05405, USA.
| | - Jon Campbell
- School of Pharmacy University of Colorado, Aurora, USA
| | | | | | - Mori Krantz
- Denver Health Medical Center Cardiology Division, Denver, USA.,School of Medicine, University of Colorado, Aurora, USA
| |
Collapse
|
25
|
Huang Y, Liao X, Song Z, Wang L, Xiao M, Zhong S. Evaluation of the Influence of Etiological Factors on the Economic Burden of Ischemic Stroke in Younger Patients in China Using the Trial of Org 10172 in Acute Stroke Treatment (TOAST) Classification. Med Sci Monit 2019; 25:637-642. [PMID: 30666992 PMCID: PMC6350450 DOI: 10.12659/msm.913977] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Worldwide, stroke results in healthcare costs and economic costs, particularly in patients aged <45 years. This study aimed to evaluate the factors influencing the economic burden of ischemic stroke in younger patients in China based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological classification. MATERIAL AND METHODS Retrospective review of the medical records of 961 patients aged between 18-45 years, diagnosed with acute ischemic stroke, was performed to identify healthcare costs for one year. Stroke severity was assessed using the modified Rankin Scale (mRS) score and the National Institutes of Health Stroke Scale (NIHSS) score. Stroke was categorized according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification as being due to large artery atherosclerosis (LAA), cardioembolism (CE), small artery occlusion (SAO), other determined causes (OC), and undetermined etiology (UND). RESULTS Total direct medical costs at one-year follow-up were US$10,954.14, including inpatient cost of US$5,958.44, and outpatient cost of US$3,397.60. Inpatient and total costs at one year were significantly increased in the CE subtype (P<0.001), and were significantly less in the UND subtype (P<0.001). Multivariable logistic regression analysis showed that mRS score, TOAST category, NIHSS score, and the presence of atrial fibrillation were the significant factors influencing cost at one-year follow-up and total cost in younger patients with ischemic stroke. Overall, patient costs in China were less than those in high-income countries. CONCLUSIONS In the younger patient population in China, etiological factors influenced the economic burden of ischemic stroke.
Collapse
Affiliation(s)
- Ying Huang
- Department of Neurology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China (mainland).,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi, China (mainland)
| | - Xiangping Liao
- Department of Neurology, Gannan Medical University, Ganzhou, Jiangxi, China (mainland)
| | - Zitan Song
- Department of Neurology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China (mainland).,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi, China (mainland)
| | - Linghong Wang
- Department of Neurology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China (mainland).,Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi, China (mainland)
| | - Minghui Xiao
- Department of Neurology, Wan'an County Peoples' Hospital, Ji'an, Jiangxi, China (mainland)
| | - Shanquan Zhong
- Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, Jiangxi, China (mainland)
| |
Collapse
|
26
|
Weng SW, Chen TL, Yeh CC, Lane HL, Liao CC, Shih CC. The effects of Bu Yang Huan Wu Tang on post-stroke epilepsy: a nationwide matched study. Clin Epidemiol 2018; 10:1839-1850. [PMID: 30573993 PMCID: PMC6292405 DOI: 10.2147/clep.s175677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To compare the long-term risk of epilepsy in stroke patients who use Bu Yang Huan Wu Tang (BYHWT) and those who do not. METHODS In the Taiwanese national insurance claims data, we identified newly diagnosed stroke patients receiving inpatient care in the years 2000-2004. Using propensity score-matched pairs to balance the baseline characteristics, we selected eligible stroke patients who did (n=8,971) and did not (n=8,971) receive BYHWT. These two groups were followed up until the end of 2009 to track the occurrence of epilepsy. We used Cox proportional hazard models to calculate the adjusted HRs and 95% CIs for post-stroke epilepsy during the follow-up period according to BYHWT use. RESULTS Compared with the control group, stroke patients with BYHWT had a reduced risk of epilepsy during the 5-9 years of the follow-up period (HR 0.69, 95% CI 0.61-0.77). The association between BYHWT and reduced post-stroke epilepsy was significant in various subgroups of stroke patients. There was a dose-dependent decrease in the frequency of epilepsy with increasing quantities of BYHWT use from 1 package (HR 0.77, 95% CI 0.66-0.90) to ≥6 packages (HR 0.52, 95% CI 0.42-0.65). CONCLUSION Stroke patients who received BYHWT therapy had a reduced long-term risk of epilepsy, and the beneficial effect could be observed in various subgroups. However, future clinical trials will be necessary to corroborate the present findings and identify the biochemical mechanism involved.
Collapse
Affiliation(s)
- Shu-Wen Weng
- Department of Chinese Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Hsin-Long Lane
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan,
| | - Chien-Chang Liao
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan,
- Program for the Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan,
| |
Collapse
|
27
|
Einarson TR, Acs A, Ludwig C, Panton UH. Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:881-890. [PMID: 30005761 DOI: 10.1016/j.jval.2017.12.019] [Citation(s) in RCA: 171] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/08/2017] [Accepted: 12/06/2017] [Indexed: 05/22/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVDs) constitute major comorbidities in type 2 diabetes mellitus (T2DM), contributing substantially to treatment costs for T2DM. An updated overview of the economic burden of CVD in T2DM has not been presented to date. OBJECTIVE To systematically review published articles describing the costs associated with treating CVD in people with T2DM. METHODS Two reviewers searched MEDLINE, Embase, and abstracts from scientific meetings to identify original research published between 2007 and 2017, with no restrictions on language. Studies reporting direct costs at either a macro level (e.g., burden of illness for a country) or a micro level (e.g., cost incurred by one patient) were included. Extracted costs were inflated to 2016 values using local consumer price indexes, converted into US dollars, and presented as cost per patient per year. RESULTS Of 81 identified articles, 24 were accepted for analysis, of which 14 were full articles and 10 abstracts. Cardiovascular comorbidities in patients with T2DM incurred a significant burden at both the population and patient levels. From a population level, CVD costs contributed between 20% and 49% of the total direct costs of treating T2DM. The median annual costs per patient for CVD, coronary artery disease, heart failure, and stroke were, respectively, 112%, 107%, 59%, and 322% higher compared with those for T2DM patients without CVD. On average, treating patients with CVD and T2DM resulted in a cost increase ranging from $3418 to $9705 compared with treating patients with T2DM alone. CONCLUSIONS Globally, CVD has a substantial impact on direct medical costs of T2DM at both the patient and population levels.
Collapse
Affiliation(s)
- Thomas R Einarson
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
28
|
Raluy-Callado M, Cox A, MacLachlan S, Bakheit AM, Moore AP, Dinet J, Gabriel S. A retrospective study to assess resource utilization and costs in patients with post-stroke spasticity in the United Kingdom. Curr Med Res Opin 2018; 34:1317-1324. [PMID: 29490512 DOI: 10.1080/03007995.2018.1447449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Post-stroke spasticity (PSS) is a common complication following stroke. This study describes the differences in healthcare resource utilization between patients who do and do not develop PSS in the UK. METHODS Adults registered in The Health Improvement Network database with a recorded stroke between 2007 and 2011 were included. PSS was identified through Read codes; machine learning was used to retrospectively identify unrecorded PSS events. Patients with diagnosed or predicted PSS in the 12 months after stroke were matched to those with no PSS on age, sex, number of strokes, socioeconomic status, and comorbidities using the nearest neighbor algorithm. Utilization and costs associated with general practitioner visits, nurse visits, hospitalizations, referrals to specialists, laboratory tests, and medications in the 12 months after stroke were compared. RESULTS Overall, 2,951 PSS cases were matched to 37,753 controls. During the first year, more PSS cases visited a physiotherapist (19% vs 7%) and occupational therapist (12% vs 5%) compared to controls. A greater proportion of cases were also referred to specialists (76% vs 64%) and hospitalized (33% vs 9%) compared to controls. Medication for spasticity was, on average, 14.68 prescriptions for cases and 5.64 for controls. Total mean costs per patient were £1,270 (standard deviation [SD] = 772) and £635 (SD = 273) for cases and controls, respectively. CONCLUSION Costs after stroke for patients developing PSS are twice as high compared to patients who do not develop it, with the major driver being the number of hospital admissions. This highlights the need for better recording and closer management of PSS.
Collapse
Affiliation(s)
| | | | | | | | - A Peter Moore
- c The Walton Centre NHS Foundation Trust , Liverpool , UK
| | - Jerome Dinet
- d Ipsen Pharma SAS , Boulogne-Billancourt , France
| | | |
Collapse
|
29
|
Endo M, Haruyama Y, Muto G, Yokoyama K, Kojimahara N, Yamaguchi N. Employment sustainability after return to work among Japanese stroke survivors. Int Arch Occup Environ Health 2018; 91:717-724. [PMID: 29802486 PMCID: PMC6060773 DOI: 10.1007/s00420-018-1319-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Abstract
Purpose Few studies have investigated the work continuance rate among stroke survivors who return to work (RTW). The objective of this study was to investigate work sustainability after RTW and the causes of recurrent sickness absence (RSA) among Japanese stroke survivors. Methods Data on stroke survivors were collected from an occupational health register. The inclusion criteria were as follows: employees who were aged 15–60 years old and returned to work after an episode of sick leave due to a clinically certified stroke that was diagnosed during the period from 1 January 2000 through 31 December 2011. Results 284 employees returned to work after their first episode of stroke-induced sick leave. The work continuance rate for all subjects was 78.8 and 59.0% at one and 5 years after the subjects’ RTW, respectively. After returning to work, the subjects worked for a mean of 7.0 years. Of 284 employees who returned to work, 86 (30.3%) experienced RSA. The RSA were caused by recurrent strokes in 57.0% (49/86) of cases, mental disorders in 20.9% (18/86) of cases, and fractures (often due to accidents involving steps at train stations or the subject’s home) in 10.5% (9/86) of cases. 21 employees resigned after returning to work. The resignation rates at 1 and 5 years were 4.9 and 7.6%, respectively. According to the multivariate analysis including all variables, the subjects in the ≥ 50 year group were at greater risk of work discontinuation than the ≤ 49 year (reference) age group (HR: 2.26, 95% CI 1.39–3.68). Conclusions Occupational health professionals need to provide better RTW support to stroke survivors and should pay particularly close attention to preventing recurrent strokes, mental disorders, and fractures.
Collapse
Affiliation(s)
- Motoki Endo
- Department of Public Health, Tokyo Women's Medical University, Tokyo, 162-8666, Japan.
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University, Mibu, Japan
| | - Go Muto
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Kazuhito Yokoyama
- Department of Epidemiology and Environmental Health, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Noriko Kojimahara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
| | - Naohito Yamaguchi
- Department of Public Health, Tokyo Women's Medical University, Tokyo, 162-8666, Japan
| |
Collapse
|
30
|
Luengo-Fernandez R, Howard DPJ, Nichol KG, Dobell E, Rothwell PM. Hospital and Institutionalisation Care Costs after Limb and Visceral Ischaemia Benchmarked Against Stroke: Long-Term Results of a Population Based Cohort Study. Eur J Vasc Endovasc Surg 2018; 56:271-281. [PMID: 29653901 PMCID: PMC6105571 DOI: 10.1016/j.ejvs.2018.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE/BACKGROUND There are few published data on the acute care or long-term costs after acute/critical limb or visceral ischaemia (ACLVI) events. Using data from patients with acute events in a population based incidence study (Oxford Vascular Study), the present study aimed to determine the long-term costs after an ACLVI event. METHODS All patients with first ever incident ACLVI from 2002 to 2012 were included. Analysis was based on follow up until January 2017, with all patients having full 5 year follow up. Multivariate regressions were used to assess baseline and subsequent predictors of total 5 year hospital care costs. Overall costs after an ACLVI event were benchmarked against those after stroke in the same population, during the same period. RESULTS Among 351 patients with an ACLVI event, mean 5 year total care costs were €35,211 (SD 50,500), of which €6443 (18%) were due to long-term institutionalisation. Costs differed by type of event (acute visceral ischaemia €16,476; acute limb ischaemia €24,437; critical limb ischaemia €46,281; p < 0.001). Results of the multivariate analyses showed that patients with diabetes and those undergoing above knee amputations incurred additional costs of €11,804 (p = 0.014) and €25,692 (p < 0.001), respectively. Five year hospital care costs after an ACLVI event were significantly higher than after stroke (€28,768 vs. €22,623; p = 0.004), but similar after including long-term costs of institutionalisation (€35,211 vs. €35,391; p = 0.957). CONCLUSION Long-term care costs after an ACLVI event are considerable, especially after critical limb ischaemia. Hospital care costs were significantly higher than for stroke over the long term, and were similar after inclusion of costs of institutionalisation.
Collapse
Affiliation(s)
- Ramon Luengo-Fernandez
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Dominic P J Howard
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Vascular Surgery, Oxford University Hospitals NHS Foundation Trust, UK
| | - Kathleen G Nichol
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - Emily Dobell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Oxford School of Public Health, Nuffield Department of Population Health, University of Oxford, UK
| | - Peter M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.
| | | |
Collapse
|
31
|
Högberg D, Mani K, Wanhainen A, Svensjö S. Clinical Effect and Cost-Effectiveness of Screening for Asymptomatic Carotid Stenosis: A Markov Model. Eur J Vasc Endovasc Surg 2018; 55:819-827. [PMID: 29636252 DOI: 10.1016/j.ejvs.2018.02.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/24/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/BACKGROUND The cost-effectiveness of screening depends on the cost of screening, prevalence of asymptomatic carotid artery stenosis (ACAS), and the potential effect of medical intervention in reducing the risk of stroke. The aim of the study was to determine the threshold values for these parameters in order for screening for ACAS to be cost-effective. METHODS The clinical effect and cost-effectiveness of ultrasound screening for ACAS with subsequent initiation of preventive therapy versus not screening was assessed in a Markov model with a lifetime perspective. Key parameters, including stroke risk, all cause mortality, and costs, were based on contemporary published data, population statistics, and data from an ongoing screening program in Uppsala county (population 300,000), Sweden. Prevalence of ACAS (2%) and the rate of best medical treatment (BMT; 40%) were based on data from a male Swedish population recently screened for ACAS. The required stroke risk reduction from BMT, incremental cost-efficiency ratio (ICER), absolute risk reduction for stroke (ARR), and number needed to screen (NNS) were calculated. RESULTS Screening was cost-effective at an ICER of €5744 per incremental quality adjusted life year (QALY) gained. ARR was 135 per 100,000 screened, NNS was 741, and QALYs gained were 6700 per 100,000 invited. At a willingness to pay (WTP) threshold of €50,000 per QALY the minimum required stroke risk reduction from BMT was 22%. The assumed degree of stroke risk reduction was the most important determinant of cost-efficiency. CONCLUSION A moderate (22%) reduction in the risk of stroke was required for an ACAS screening strategy to be cost-effective at a WTP of €50,000/QALY. Targeting populations with a higher prevalence of ACAS could further improve cost-efficiency.
Collapse
Affiliation(s)
- Dominika Högberg
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden; Department Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Kevin Mani
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Anders Wanhainen
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Sverker Svensjö
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University Hospital, Uppsala, Sweden; Department of Surgery, Falun County Hospital, Falun, Sweden; Centre for Clinical Research, Falun, Sweden
| |
Collapse
|
32
|
Landeiro F, Wace H, Ghinai I, Nye E, Mughal S, Walsh K, Roberts N, Lecomte P, Wittenberg R, Wolstenholme J, Handels R, Roncancio-Diaz E, Potashman MH, Tockhorn-Heidenreich A, Gray AM. Resource utilisation and costs in predementia and dementia: a systematic review protocol. BMJ Open 2018; 8:e019060. [PMID: 29362261 PMCID: PMC5988053 DOI: 10.1136/bmjopen-2017-019060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Dementia is the fastest growing major cause of disability globally with a mounting social and financial impact for patients and their families but also to health and social care systems. This review aims to systematically synthesise evidence on the utilisation of resources and costs incurred by patients and their caregivers and by health and social care services across the full spectrum of dementia, from its preceding preclinical stage to end of life. The main drivers of resources used and costs will also be identified. METHODS AND ANALYSIS A systematic literature review was conducted in MEDLINE, EMBASE, CDSR, CENTRAL, DARE, EconLit, CEA Registry, TRIP, NHS EED, SCI, RePEc and OpenGrey between January 2000 and beginning of May 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. The reporting of costing methodology will be assessed using the British Medical Journal checklist. A narrative synthesis of all studies will be presented for resources used and costs incurred, by level of disease severity when available. If feasible, the data will be synthesised using appropriate statistical techniques. ETHICS AND DISSEMINATION Included articles will be reviewed for an ethics statement. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer's disease spectrum for better care: multi-modal data access platform (ROADMAP). TRIAL REGISTRATION NUMBER CRD42017071413.
Collapse
Affiliation(s)
- Filipa Landeiro
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Helena Wace
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Isaac Ghinai
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Elsbeth Nye
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Seher Mughal
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Katie Walsh
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - Pascal Lecomte
- Global Head Health Economic Modelling and Methodology, Novartis Pharmaceutical AG, Basel, Switzerland
| | - Raphael Wittenberg
- Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Jane Wolstenholme
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Ron Handels
- Department of Psychiatry and Neuropsychology, Maastricht University, School for Mental Health and Neurosciences, Alzheimer Centre Limburg, Maastricht, The Netherlands
- Division of Neurogeriatrics, Department of Neurobiology, Care Science and Society, Karolinska Institute, Stockholm, Sweden
| | | | | | | | - Alastair M Gray
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| |
Collapse
|
33
|
Williamson S, Landeiro F, McConnell T, Fulford-Smith L, Javaid MK, Judge A, Leal J. Costs of fragility hip fractures globally: a systematic review and meta-regression analysis. Osteoporos Int 2017; 28:2791-2800. [PMID: 28748387 DOI: 10.1007/s00198-017-4153-6] [Citation(s) in RCA: 142] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/06/2017] [Indexed: 12/31/2022]
Abstract
Purpose This study was conducted in order to systematically review the costs of hip fractures globally and identify drivers of differences in costs. Methods A systematic review was conducted to identify studies reporting patient level fragility hip fracture costs between 1990 and 2015. We extracted data on the participants and costs from these studies. Cost data concerning the index hospitalisation were pooled, and a meta-regression was used to examine its potential drivers. We also pooled data on the first-year costs following hip fracture and considered healthcare, social care as well as other cost categories if reported by studies. Results One hundred and thirteen studies reported costs of hip fracture based on patient level data. Patients developing complications as well as patients enrolled in intervention arms of comparative studies were found to have significantly higher costs compared to the controls. The pooled estimate of the cost for the index hospitalisation was $10,075. Health and social care costs at 12 months were $43,669 with inpatient costs being their major driver. Meta-regression analysis identified age, gender and geographic region as being significantly associated with the differences in costs for the index hospitalisation. Conclusion Hip fracture poses a significant economic burden and variation exists in their costs across different regions. We found that there was a considerable variation across studies in terms of study design, methodology, follow-up period, costs considered and results reported that highlights the need for more standardisation in this area of research.
Collapse
Affiliation(s)
- S Williamson
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - F Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - T McConnell
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - L Fulford-Smith
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - M K Javaid
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A Judge
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| |
Collapse
|
34
|
Comparison of the Time Course of Return to Work After Stroke Between Two Cohort Studies in Japan. J UOEH 2017; 38:311-315. [PMID: 27980314 DOI: 10.7888/juoeh.38.311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The conditions for stroke rehabilitation such as individual therapeutic procedure and medical treatment system in Japan have drastically changed over the past decade: increasing incidence of ischemic stroke, the use of intravenous recombinant tissue plasminogen activator, hospital specialization, introduction of convalescent rehabilitation wards, and public long-term care insurance. However, it is not known whether these changes have influenced the time course of return to work (RTW) after stroke. In this study we compared the time course of RTW after stroke in Japan that was reported in two cohort studies performed 20 years apart. The cumulative rate of RTW after first stroke was similar in the two studies, even though they were separated by an interval of two decades. This shows that advances in stroke rehabilitation have not impacted RTW, and we suggest that the social security system, particularly sickness benefit, has a strong influence on RTW.
Collapse
|
35
|
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.
Collapse
|
36
|
Akhigbe T, Zolnourian A. Role of surgery in the management of patients with supratentorial spontaneous intracerebral hematoma: Critical appraisal of evidence. J Clin Neurosci 2017; 39:35-38. [DOI: 10.1016/j.jocn.2017.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/10/2017] [Indexed: 11/17/2022]
|
37
|
Kristensen OH, Stenager E, Dalgas U. Muscle Strength and Poststroke Hemiplegia: A Systematic Review of Muscle Strength Assessment and Muscle Strength Impairment. Arch Phys Med Rehabil 2017; 98:368-380. [DOI: 10.1016/j.apmr.2016.05.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022]
|
38
|
Salisbury C, O’Cathain A, Thomas C, Edwards L, Montgomery AA, Hollinghurst S, Large S, Nicholl J, Pope C, Rogers A, Lewis G, Fahey T, Yardley L, Brownsell S, Dixon P, Drabble S, Esmonde L, Foster A, Garner K, Gaunt D, Horspool K, Man MS, Rowsell A, Segar J. An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundHealth services internationally are exploring the potential of telehealth to support the management of the growing number of people with long-term conditions (LTCs).AimTo develop, implement and evaluate new care programmes for patients with LTCs, focusing on two common LTCs as exemplars: depression or high cardiovascular disease (CVD) risk.MethodsDevelopmentWe synthesised quantitative and qualitative evidence on the effectiveness of telehealth for LTCs, conducted a qualitative study based on interviews with patients and staff and undertook a postal survey to explore which patients are interested in different forms of telehealth. Based on these studies we developed a conceptual model [TElehealth in CHronic disease (TECH) model] as a framework for the development and evaluation of the Healthlines Service for patients with LTCs.ImplementationThe Healthlines Service consisted of regular telephone calls to participants from health information advisors, supporting them to make behaviour change and to use tailored online resources. Advisors sought to optimise participants’ medication and to improve adherence.EvaluationThe Healthlines Service was evaluated with linked pragmatic randomised controlled trials comparing the Healthlines Service plus usual care with usual care alone, with nested process and economic evaluations. Participants were adults with depression or raised CVD risk recruited from 43 general practices in three areas of England. The primary outcome was response to treatment and the secondary outcomes included anxiety (depression trial), individual risk factors (CVD risk trial), self-management skills, medication adherence, perceptions of support, access to health care and satisfaction with treatment.Trial resultsDepression trialIn total, 609 participants were randomised and the retention rate was 86%. Response to treatment [Patient Health Questionnaire 9-items (PHQ-9) reduction of ≥ 5 points and score of < 10 after 4 months] was higher in the intervention group (27%, 68/255) than in the control group (19%, 50/270) [odds ratio 1.7, 95% confidence interval (CI) 1.1 to 2.5;p = 0.02]. Anxiety also improved. Intervention participants reported better access to health support, greater satisfaction with treatment and small improvements in self-management, but not improved medication adherence.CVD risk trialIn total, 641 participants were randomised and the retention rate was 91%. Response to treatment (maintenance of/reduction in QRISK®2 score after 12 months) was higher in the intervention group (50%, 148/295) than in the control group (43%, 124/291), which does not exclude a null effect (odds ratio 1.3, 95% CI 1.0 to 1.9;p = 0.08). The intervention was associated with small improvements in blood pressure and weight, but not smoking or cholesterol. Intervention participants were more likely to adhere to medication, reported better access to health support and greater satisfaction with treatment, but few improvements in self-management.The Healthlines Service was likely to be cost-effective for CVD risk, particularly if the benefits are sustained, but not for depression. The intervention was implemented largely as planned, although initial delays and later disruption to delivery because of the closure of NHS Direct may have adversely affected participant engagement.ConclusionThe Healthlines Service, designed using an evidence-based conceptual model, provided modest health benefits and participants valued the better access to care and extra support provided. This service was cost-effective for CVD risk but not depression. These findings of small benefits at extra cost are consistent with previous pragmatic research on the implementation of comprehensive telehealth programmes for LTCs.Trial registrationCurrent Controlled Trials ISRCTN14172341 (depression trial) and ISRCTN27508731 (CVD risk trial).FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
Collapse
Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alicia O’Cathain
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Clare Thomas
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Jon Nicholl
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Simon Brownsell
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sarah Drabble
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Lisa Esmonde
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Alexis Foster
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Katy Garner
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Kim Horspool
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Mei-See Man
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Alison Rowsell
- Centre for Applications of Health Psychology, School of Psychology, University of Southampton, Southampton, UK
| | - Julia Segar
- Centre for Primary Care, University of Manchester, Manchester, UK
| |
Collapse
|
39
|
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.
Collapse
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
| |
Collapse
|
40
|
Dixon P, Hollinghurst S, Ara R, Edwards L, Foster A, Salisbury C. Cost-effectiveness modelling of telehealth for patients with raised cardiovascular disease risk: evidence from a cohort simulation conducted alongside the Healthlines randomised controlled trial. BMJ Open 2016; 6:e012355. [PMID: 27670521 PMCID: PMC5051382 DOI: 10.1136/bmjopen-2016-012355] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To investigate the long-term cost-effectiveness (measured as the ratio of incremental NHS cost to incremental quality-adjusted life years) of a telehealth intervention for patients with raised cardiovascular disease (CVD) risk. DESIGN A cohort simulation model developed as part of the economic evaluation conducted alongside the Healthlines randomised controlled trial. SETTING Patients recruited through primary care, and intervention delivered via telehealth service. PARTICIPANTS Participants with a 10-year CVD risk ≥20%, as measured by the QRISK2 algorithm, and with at least 1 modifiable risk factor, individually randomised from 42 general practices in England. INTERVENTION A telehealth service delivered over a 12-month period. The intervention involved a series of responsive, theory-led encounters between patients and trained health information advisors who provided access to information resources and supported medication adherence and coordination of care. PRIMARY AND SECONDARY OUTCOME MEASURES Cost-effectiveness measured by net monetary benefit over the simulated lifetime of trial participants from a UK National Health Service perspective. RESULTS The probability that the intervention was cost-effective depended on the duration of the effect of the intervention. The intervention was cost-effective with high probability if effects persisted over the lifetime of intervention recipients. The probability of cost-effectiveness was lower for shorter durations of effect. CONCLUSIONS The intervention was likely to be cost-effective under a lifetime perspective. TRIAL REGISTRATION NUMBER ISRCTN27508731; Results.
Collapse
Affiliation(s)
- Padraig Dixon
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Roberta Ara
- ScHARR, The University of Sheffield, Sheffield, UK
| | - Louisa Edwards
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Chris Salisbury
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| |
Collapse
|
41
|
Nicholson G, Gandra SR, Halbert RJ, Richhariya A, Nordyke RJ. Patient-level costs of major cardiovascular conditions: a review of the international literature. CLINICOECONOMICS AND OUTCOMES RESEARCH 2016; 8:495-506. [PMID: 27703385 PMCID: PMC5036826 DOI: 10.2147/ceor.s89331] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Robust cost estimates of cardiovascular (CV) events are required for assessing health care interventions aimed at reducing the economic burden of major adverse CV events. This review synthesizes international cost estimates of CV events. METHODS MEDLINE database was searched electronically for English language studies published during 2007-2012, with cost estimates for CV events of interest - unstable angina, myocardial infarction, heart failure, stroke, and CV revascularization. Included studies provided at least one estimate of patient-level direct costs in adults for any identified country. Information on study characteristics and cost estimates were collected. All costs were adjusted for inflation to 2013 values. RESULTS Across the 114 studies included, the average cost was US $6,466 for unstable angina, $11,664 for acute myocardial infarction, $11,686 for acute heart failure, $11,635 for acute ischemic stroke, $37,611 for coronary artery bypass graft, and $13,501 for percutaneous coronary intervention. The ranges for cost estimates varied widely across countries with US cost estimate being at least twice as high as European Union costs for some conditions. Few studies were found on populations outside the US and European Union. CONCLUSION This review showed wide variation in the cost of CV events within and across countries, while showcasing the continuing economic burden of CV disease. The variability in costs was primarily attributable to differences in study population, costing methodologies, and reporting differences. Reliable cost estimates for assessing economic value of interventions in CV disease are needed.
Collapse
|
42
|
Weng SW, Chen TL, Yeh CC, Liao CC, Lane HL, Lin JG, Shih CC. An investigation of the use of acupuncture in stroke patients in Taiwan: a national cohort study. Altern Ther Health Med 2016; 16:321. [PMID: 27566677 PMCID: PMC5002127 DOI: 10.1186/s12906-016-1272-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 08/09/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Acupuncture is considered a complementary and alternative medicine in many countries. The purpose of this study was to report the pattern of acupuncture use and associated factors in patients with stroke. METHODS We used claims data from Taiwan's National Health Insurance Research Database and identified 285001 new-onset stroke patients in 2000-2008 from 23 million people allover Taiwan. The use of acupuncture treatment after stroke within one year was identified. We compared sociodemographics, coexisting medical conditions, and stroke characteristics between stroke patients who did and did not receive acupuncture treatment. RESULTS The use of acupuncture in stroke patients increased from 2000 to 2008. Female gender, younger age, white-collar employee status, higher income, and residence in areas with more traditional Chinese medicine (TCM) physicians were factors associated with acupuncture use in stroke patients. Ischemic stroke (odds ratio [OR] 1.21, 95 % confidence interval [CI] 1.15-1.28), having no renal dialysis (OR 2.76, 95 % CI 2.45-3.13), receiving rehabilitation (OR 3.20, 95 % CI 3.13-3.27) and longer hospitalization (OR 1.23, 95 % CI 1.19-1.27) were also associated with acupuncture use. Stroke patients using rehabilitation services were more likely to have more acupuncture visits and a higher expenditure on acupuncture compared with stroke patients who did not receive rehabilitation services. CONCLUSIONS The application of acupuncture in stroke patients is well accepted and increasing in Taiwan. The use of acupuncture in stroke patients is associated with sociodemographic factors and clinical characteristics.
Collapse
|
43
|
Weng SW, Liao CC, Yeh CC, Chen TL, Lane HL, Lin JG, Shih CC. Risk of epilepsy in stroke patients receiving acupuncture treatment: a nationwide retrospective matched-cohort study. BMJ Open 2016; 6:e010539. [PMID: 27412100 PMCID: PMC4947771 DOI: 10.1136/bmjopen-2015-010539] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate the risk of epilepsy in stroke patients receiving and not receiving acupuncture treatment. DESIGN Retrospective cohort study. SETTING This study was based on Taiwan's National Health Insurance Research Database that included information on stroke patients hospitalised between 1 January 2000 and 31 December 2004. PARTICIPANTS We identified 42 040 patients hospitalised with newly diagnosed stroke who were aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES We compared incident epilepsy during the follow-up period until the end of 2009 in stroke patients who were and were not receiving acupuncture. The adjusted HRs and 95% CIs of epilepsy associated with acupuncture were calculated using multivariate Cox proportional hazard regression. RESULTS Stroke patients who received acupuncture treatment (9.8 per 1000 person-years) experienced a reduced incidence of epilepsy compared to those who did not receive acupuncture treatment (11.5 per 1000 person-years), with an HR of 0.74 (95% CI 0.68 to 0.80) after adjustment for sociodemographic factors and coexisting medical conditions. Acupuncture treatment was associated with a decreased risk of epilepsy, particularly among stroke patients aged 20-69 years. The log-rank test probability curve indicated that stroke patients receiving acupuncture treatment had a reduced probability of epilepsy compared with individuals who did not receive acupuncture treatment during the follow-up period (p<0.0001). CONCLUSIONS Stroke patients who received acupuncture treatment had a reduced risk of epilepsy compared with those not receiving acupuncture treatment. However, the protective effects associated with acupuncture treatment require further validation in prospective cohort studies.
Collapse
Affiliation(s)
- Shu-Wen Weng
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Chinese Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Chien-Chang Liao
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan
- Department of Surgery, University of Illinois, Chicago, Illinois, USA
| | - Ta-Liang Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsin-Long Lane
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Jaung-Geng Lin
- Graduate Institute of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
| | - Chun-Chuan Shih
- School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
- Program for the Clinical Drug Discovery from Botanical Herbs, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
44
|
Steinhubl SR, Mehta RR, Ebner GS, Ballesteros MM, Waalen J, Steinberg G, Van Crocker P, Felicione E, Carter CT, Edmonds S, Honcz JP, Miralles GD, Talantov D, Sarich TC, Topol EJ. Rationale and design of a home-based trial using wearable sensors to detect asymptomatic atrial fibrillation in a targeted population: The mHealth Screening To Prevent Strokes (mSToPS) trial. Am Heart J 2016; 175:77-85. [PMID: 27179726 DOI: 10.1016/j.ahj.2016.02.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/17/2016] [Indexed: 01/06/2023]
Abstract
Efficient methods for screening populations for undiagnosed atrial fibrillation (AF) are needed to reduce its associated mortality, morbidity, and costs. The use of digital technologies, including wearable sensors and large health record data sets allowing for targeted outreach toward individuals at increased risk for AF, might allow for unprecedented opportunities for effective, economical screening. The trial's primary objective is to determine, in a real-world setting, whether using wearable sensors in a risk-targeted screening population can diagnose asymptomatic AF more effectively than routine care. Additional key objectives include (1) exploring 2 rhythm-monitoring strategies-electrocardiogram-based and exploratory pulse wave-based-for detection of new AF, and (2) comparing long-term clinical and resource outcomes among groups. In all, 2,100 Aetna members will be randomized 1:1 to either immediate or delayed monitoring, in which a wearable patch will capture a single-lead electrocardiogram during the first and last 2 weeks of a 4-month period beginning immediately or 4 months after enrollment, respectively. An observational, risk factor-matched control group (n = 4,000) will be developed from members who did not receive an invitation to participate. The primary end point is the incidence of new AF in the immediate- vs delayed-monitoring arms at the end of the 4-month monitoring period. Additional efficacy and safety end points will be captured at 1 and 3 years. The results of this digital medicine trial might benefit a substantial proportion of the population by helping identify and refine screening methods for undiagnosed AF.
Collapse
|
45
|
Endo M, Sairenchi T, Kojimahara N, Haruyama Y, Sato Y, Kato R, Yamaguchi N. Sickness absence and return to work among Japanese stroke survivors: a 365-day cohort study. BMJ Open 2016; 6:e009682. [PMID: 26729388 PMCID: PMC4716216 DOI: 10.1136/bmjopen-2015-009682] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES The objective of this study was to investigate the cumulative return to work (RTW) rate and to clarify the predictors of the time to full-time RTW (full RTW) and resignation among Japanese stroke survivors, within the 365-day period following their initial day of sickness absence due to stroke. SETTING This study was based on tertiary prevention of occupational health in large-scaled Japanese companies of various industries. PARTICIPANTS The participants in this study were 382 Japanese workers who experienced an episode of sickness leave due to clinically certified stroke diagnosed between 1 January 2000 and 31 December 2011. Data were obtained from an occupational health register. Participants were followed up for 365 days after the start day of the first sickness absence. The cumulative RTW rates by Kaplan-Meier estimates and predictors for time to full RTW and resignation by Cox regression were calculated. RESULTS A total of 382 employees had their first sickness absence due to stroke during the 12-year follow-up period. The cumulative full RTW rates at 60, 120, 180 and 365 days were 15.1%, 33.6%, 43.5% and 62.4%, respectively. Employees who took sick leave due to cerebral haemorrhage had a longer time to full RTW (HR, 0.50; 95% CI 0.36 to 0.69) than those with cerebral infarction. Older employees (over 50 years of age) demonstrated a shorter time to resignation than younger employees (HR, 3.30; 95% CI 1.17 to 9.33). Manual workers had a longer time to resignation than non-manual workers (HR, 0.24; 95% CI 0.07 to 0.78). CONCLUSIONS Cumulative RTW rates depended on the subtype of stroke, and older age was a predictor of resignation.
Collapse
Affiliation(s)
- Motoki Endo
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University, Mibu Town, Japan
| | - Noriko Kojimahara
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University, Mibu Town, Japan
| | - Yasuto Sato
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Rika Kato
- Oyama Health Management Center, Health Promotion Center, Komatsu Ltd, Oyama City, Japan
| | - Naohito Yamaguchi
- Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
46
|
Peltola M, Seppälä TT, Malmivaara A, Belicza É, Numerato D, Goude F, Fletcher E, Heijink R. Individual and Regional-level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries. HEALTH ECONOMICS 2015; 24 Suppl 2:38-52. [PMID: 26633867 DOI: 10.1002/hec.3264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Using patient-level data for cerebral infarction cases in 2007, gathered from Finland, Hungary, Italy, the Netherlands, Scotland and Sweden, we studied the variation in risk-adjusted length of stay (LoS) of acute hospital care and 1-year mortality, both within and between countries. In addition, we analysed the variance of LoS and associations of selected regional-level factors with LoS and 1-year mortality after cerebral infarction. The data show that LoS distributions are surprisingly different across countries and that there is significant deviation in the risk-adjusted regional-level LoS in all of the countries studied. We used negative binomial regression to model the individual-level LoS, and random intercept models and ordinary least squares regression for the regional-level analysis of risk-adjusted LoS, variance of LoS, 1-year risk-adjusted mortality and crude mortality for a period of 31-365 days. The observed variations between regions and countries in both LoS and mortality were not fully explained by either patient-level or regional-level factors. The results indicate that there may exist potential for efficiency gains in acute hospital care of cerebral infarction and that healthcare managers could learn from best practices.
Collapse
Affiliation(s)
- Mikko Peltola
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | - Timo T Seppälä
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | - Antti Malmivaara
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Dino Numerato
- Centre for Research on Health and Social Care Management, Bocconi University, Milano, Italy
- Department of Sociology, Faculty of Social Sciences, Charles University, Prague, The Czech Republic
| | - Fanny Goude
- Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | | | - Richard Heijink
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
47
|
Hamilton W, Huang H, Seiber E, Lo W. Cost and Outcome in Pediatric Ischemic Stroke. J Child Neurol 2015; 30:1483-8. [PMID: 25660132 DOI: 10.1177/0883073815570673] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/08/2015] [Indexed: 11/17/2022]
Abstract
The cost of childhood stroke receives little notice. The authors examined potential drivers of cost and outcome to test whether (1) neonatal strokes cost less than childhood strokes, (2) associated diseases influence cost, (3) arterial ischemic stroke is more costly than sinovenous thrombosis, and (4) cost correlates with outcome. The authors reviewed records of 111 children who sustained arterial ischemic stroke or sinovenous thrombosis between 2005 and 2010 to identify costs for the following year. They assessed outcomes in 46 with the Recovery and Recurrence Questionnaire and the Pediatric Quality of Life Inventory. Neonatal strokes cost less than childhood stroke. Strokes associated with congenital heart disease or vasculopathy cost the most, while perinatal or idiopathic strokes cost the least. Higher costs are correlated with worse impairment and poorer quality of life. Stroke etiology significantly influences the cost of pediatric stroke. Future cost-benefit studies must consider etiology when estimating the incremental costs associated with stroke.
Collapse
Affiliation(s)
- William Hamilton
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
| | - Haijuan Huang
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA Department of Neurology, Children's Hospital of Fudan University, Shanghai, China
| | - Eric Seiber
- College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Warren Lo
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
48
|
Moretti A, Ferrari F, Villa RF. Pharmacological therapy of acute ischaemic stroke: Achievements and problems. Pharmacol Ther 2015; 153:79-89. [DOI: 10.1016/j.pharmthera.2015.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 06/03/2015] [Indexed: 01/04/2023]
|
49
|
Nguyen VQ, PrvuBettger J, Guerrier T, Hirsch MA, Thomas JG, Pugh TM, Rhoads CF. Factors Associated With Discharge to Home Versus Discharge to Institutional Care After Inpatient Stroke Rehabilitation. Arch Phys Med Rehabil 2015; 96:1297-303. [DOI: 10.1016/j.apmr.2015.03.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 03/04/2015] [Accepted: 03/14/2015] [Indexed: 11/27/2022]
|
50
|
Pietzsch JB, Liu S, Garner AM, Kezirian EJ, Strollo PJ. Long-Term Cost-Effectiveness of Upper Airway Stimulation for the Treatment of Obstructive Sleep Apnea: A Model-Based Projection Based on the STAR Trial. Sleep 2015; 38:735-44. [PMID: 25348126 DOI: 10.5665/sleep.4666] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 10/05/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Upper airway stimulation (UAS) is a new approach to treat moderate-to-severe obstructive sleep apnea. Recently, 12-month data from the Stimulation Treatment for Apnea Reduction (STAR) trial were reported, evaluating the effectiveness of UAS in patients intolerant or non-adherent to continuous positive airway pressure therapy. Our objective was to assess the cost-effectiveness of UAS from a U.S. payer perspective. DESIGN A 5-state Markov model was used to predict cardiovascular endpoints (myocardial infarction [MI], stroke, hypertension), motor vehicle collisions (MVC), mortality, quality-adjusted life years (QALYs), and costs. We computed 10-year relative event risks and the lifetime incremental cost-effectiveness ratio (ICER) in $/QALY, comparing UAS therapy to no treatment under the assumption that the STAR trial-observed reduction in mean apnea-hypopnea index from 32.0 to 15.3 events/h was maintained. Costs and effects were discounted at 3% per year. SETTING U.S. healthcare system; third-party payer perspective. PARTICIPANTS 83% male cohort with mean age of 54.5 years. INTERVENTIONS UAS vs. no treatment. MEASUREMENTS AND RESULTS UAS substantially reduced event probabilities over 10 years (relative risks: MI 0.63; stroke 0.75; MVC 0.34), and was projected to add 1.09 QALYs over the patient's lifetime. Costs were estimated to increase by $42,953, resulting in a lifetime ICER of $39,471/QALY. CONCLUSIONS Relative to the acknowledged willingness-to-pay threshold of $50,000-$100,000/QALY, our results indicate upper airway stimulation is a cost-effective therapy in the U.S. healthcare system.
Collapse
Affiliation(s)
| | - Shan Liu
- Wing Tech Inc., Menlo Park, CA.,University of Washington, Seattle, WA
| | | | - Eric J Kezirian
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | | |
Collapse
|