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Nayak SS, Kuriyakose D, Polisetty LD, Patil AA, Ameen D, Bonu R, Shetty SP, Biswas P, Ulrich MT, Letafatkar N, Habibi A, Keivanlou MH, Nobakht S, Alotaibi A, Hassanipour S, Amini-Salehi E. Diagnostic and prognostic value of triglyceride glucose index: a comprehensive evaluation of meta-analysis. Cardiovasc Diabetol 2024; 23:310. [PMID: 39180024 PMCID: PMC11344391 DOI: 10.1186/s12933-024-02392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 08/05/2024] [Indexed: 08/26/2024] Open
Abstract
OBJECTIVE The present umbrella review aims to collate and summarize the findings from previous meta-analyses on the Triglyceride and Glucose (TyG) Index, providing insights to clinicians, researchers, and policymakers regarding the usefulness of this biomarker in various clinical settings. METHODS A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to April 14, 2024, without language restrictions. The AMSTAR2 checklist assessed the methodological quality of the included meta-analyses. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software. RESULTS A total of 32 studies were finally included. The results revealed significant associations between the TyG index and various health outcomes. For kidney outcomes, a high TyG index was significantly associated with an increased risk of contrast-induced nephropathy (CIN) (OR = 2.24, 95% CI: 1.82-2.77) and chronic kidney disease (CKD) (RR = 1.46, 95% CI: 1.32-1.63). High TyG index was significantly associated with an increased risk of type 2 diabetes mellitus (T2DM) (RR = 3.53, 95% CI: 2.74-4.54), gestational diabetes mellitus (GDM) (OR = 2.41, 95% CI: 1.48-3.91), and diabetic retinopathy (DR) (OR = 2.34, 95% CI: 1.31-4.19). Regarding metabolic diseases, the TyG index was significantly higher in patients with obstructive sleep apnea (OSA) (SMD = 0.86, 95% CI: 0.57-1.15), metabolic syndrome (MD = 0.83, 95% CI: 0.74-0.93), and non-alcoholic fatty liver disease (NAFLD) (OR = 2.36, 95% CI: 1.88-2.97) compared to those without these conditions. In cerebrovascular diseases, a higher TyG index was significantly associated with an increased risk of dementia (OR = 1.14, 95% CI: 1.12-1.16), cognitive impairment (OR = 2.31, 95% CI: 1.38-3.86), and ischemic stroke (OR = 1.37, 95% CI: 1.22-1.54). For cardiovascular outcomes, the TyG index showed significant associations with an increased risk of heart failure (HF) (HR = 1.21, 95% CI: 1.12-1.30), atrial fibrillation (AF) (SMD = 1.22, 95% CI: 0.57-1.87), and hypertension (HTN) (RR = 1.52, 95% CI: 1.25-1.85). CONCLUSION The TyG index is a promising biomarker for screening and predicting various medical conditions, particularly those related to insulin resistance and metabolic disorders. However, the heterogeneity and methodological quality of the included studies suggest the need for further high-quality research to confirm these findings and refine the clinical utility of the TyG index.
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Affiliation(s)
- Sandeep Samethadka Nayak
- Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA
| | - Dona Kuriyakose
- St. Joseph's Mission Hospital, Kollam District, Anchal, Kerala, India
| | - Lakshmi D Polisetty
- Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, John Dempsey Hospital, University of Connecticut, Bridgeport, CT, USA
| | - Anjali Avinash Patil
- Rajarshee Chhatrapati Shahu Maharaj Government Medical College Kolhapur Shenda park, Kolhapur, Maharashtra, India
| | - Daniyal Ameen
- Division of Hospital Medicine, Department of Internal Medicine, Bridgeport Hospital, Yale New Heaven, Bridgeport, CT, USA
| | - Rakshita Bonu
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. 82, Nallurahalli Main Road, Whitefield, Bengaluru, Karnataka, India
| | - Samatha P Shetty
- Director of Capacity Management, NYC Health Hospitals, Elmhurst, USA
| | - Pubali Biswas
- Vydehi Institute of Medical Sciences and Research Centre, Bengaluru. 82, Nallurahalli Main Road, Whitefield, Bengaluru, Karnataka, India
| | - Micheal T Ulrich
- Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | | | - Arman Habibi
- Guilan University of Medical Sciences, Rasht, Iran
| | | | - Sara Nobakht
- Guilan University of Medical Sciences, Rasht, Iran
| | | | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, P.O. Box: 41448-95655, Rasht, Iran
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Das N, Nguyen P, Ho TQA, Lee P, Robinson S, Gao L. Methods for Measuring and Valuing Informal Care: A Systematic Review and Meta-Analysis in Stroke. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02746-3. [PMID: 38977195 DOI: 10.1016/j.jval.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 05/09/2024] [Accepted: 06/30/2024] [Indexed: 07/10/2024]
Abstract
OBJECTIVES To accurately capture informal care in healthcare evaluations, rigorous approaches are required to measure and value this important care component. In this systematic review and meta-analysis, we intended to summarize the current methods of measuring and valuing informal care costs in healthcare evaluations (full and partial healthcare evaluations, including cost of illness and cost analysis) in stroke. METHODS A systematic search was conducted in MEDLINE, Embase, EconLit, and CINAHL. We used EndNote 20, Research Screener, and Covidence platforms for screening and data extraction. A meta-analysis was performed on informal care hours, and a subgroup meta-analysis was conducted based on stroke severity. RESULTS A total of 31 articles were included in the qualitative synthesis. There was variation among the studies in the informal care measurement and valuation approaches. The meta-analysis of studies where data on informal care hours were available showed an estimate of informal care hours of 25.76 per week (95% CI 13.36-38.16) with a high heterogeneity (I2 = 99.97%). The overall risk of bias in the studies was assessed as low. CONCLUSIONS Standardizing the measurement and valuation of informal care costs is essential for improving the consistency and comparability of economic evaluations. Pilot studies that incorporate standardized informal care cost valuation methods can help identify any practical challenges and capture the impact of informal care more accurately.
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Affiliation(s)
- Neha Das
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia.
| | - Phuong Nguyen
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Thi Quynh Anh Ho
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Peter Lee
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Suzanne Robinson
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
| | - Lan Gao
- Faculty of Health, School of Health & Social Development, Institute for Health Transformation, Deakin University, Melbourne Burwood Campus, Melbourne, VIC, Australia
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Eklund M, Bernfort L, Appelberg K, Engler D, Schnabel RB, Martinez C, Wallenhorst C, Boriani G, Buckley CM, Diederichsen SZ, Svendsen JH, Montaner J, Potpara T, Levin LÅ, Lyth J. The budget impact of implementing atrial fibrillation-screening in European countries. Eur Heart J Suppl 2024; 26:iv19-iv32. [PMID: 39099577 PMCID: PMC11292408 DOI: 10.1093/eurheartjsupp/suae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
A budget impact analysis estimates the short-term difference between the cost of the current treatment strategy and a new treatment strategy, in this case to implement population screening for atrial fibrillation (AF). The aim of this study is to estimate the financial impact of implementing population-based AF-screening of 75-year-olds compared with the current setting of no screening from a healthcare payer perspective in eight European countries. The net budget impact of AF-screening was estimated in country-specific settings for Denmark, Germany, Ireland, Italy, Netherlands, Serbia, Spain, and Sweden. Country-specific parameters were used to allow for variations in healthcare systems and to reflect the healthcare sector in the country of interest. Similar results can be seen in all countries AF-screening incurs savings of stroke-related costs since AF treatment reduces the number of strokes. However, the increased number of detected AF and higher drug acquisition will increase the drug costs as well as the costs of physician- and control visits. The net budget impact per invited varied from €10 in Ireland to €122 in the Netherlands. The results showed the increased costs of implementing AF-screening were mainly driven by increased drug costs and screening costs. In conclusion, across Europe, though the initial cost of screening and more frequent use of oral anti-coagulants will increase the healthcare payers' costs, introducing population screening for AF will result in savings of stroke-related costs.
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Affiliation(s)
- Michaela Eklund
- Unit of Healthcare Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Lars Bernfort
- Unit of Healthcare Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Kajsa Appelberg
- Unit of Healthcare Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Daniel Engler
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Renate B Schnabel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Germany
| | - Carlos Martinez
- Institute for Epidemiology, Statistics and Informatics GmbH, Frankfurt, Germany
| | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | - Søren Zöga Diederichsen
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital – Rigshospitalet, Inge Lehmanns Vej 7, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d’Hebron Institute of Research (VHIR) Universitat Autònoma de Barcelona, Barcelona, Spain
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville
- Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Tatjana Potpara
- Medical Faculty, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Lars-Åke Levin
- Unit of Healthcare Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Johan Lyth
- Unit of Healthcare Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Hervella P, Sampedro-Viana A, Rodríguez-Yáñez M, López-Dequidt I, Pumar JM, Mosqueira AJ, Fernández-Rodicio S, Bazarra-Barreiros M, Serena J, Silva-Blas Y, Gubern-Merida C, Rey-Aldana D, Cinza S, Campos F, Sobrino T, Castillo J, Alonso-Alonso ML, Iglesias-Rey R. Systemic biomarker associated with poor outcome after futile reperfusion. Eur J Clin Invest 2024; 54:e14181. [PMID: 38361320 DOI: 10.1111/eci.14181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 02/06/2024] [Accepted: 02/06/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Successful recanalization does not lead to complete tissue reperfusion in a considerable percentage of ischemic stroke patients. This study aimed to identify biomarkers associated with futile recanalization. Leukoaraiosis predicts poor outcomes of this phenomenon. Soluble tumour necrosis factor-like weak inducer of apoptosis (sTWEAK), which is associated with leukoaraiosis degrees, could be a potential biomarker. METHODS This study includes two cohorts of ischemic stroke patients in a multicentre retrospective observational study. Effective reperfusion, defined as a reduction of ≥8 points in the National Institutes of Health Stroke Scale (NIHSS) within the first 24 h, was used as a clinical marker of effective reperfusion. RESULTS In the first cohort study, female sex, age, and high NIHSS at admission (44.7% vs. 81.1%, 71.3 ± 13.7 vs. 81.1 ± 6.7; 16 [13, 21] vs. 23 [17, 28] respectively; p < .0001) were confirmed as predictors of futile recanalization. ROC curve analysis showed that leukocyte levels (sensitivity of 99%, specificity of 55%) and sTWEAK level (sensitivity of 92%, specificity of 88%) can discriminate between poor and good outcomes. Both biomarkers simultaneously are higher associated with outcome after effective reperfusion (OR: 2.17; CI 95% 1.63-4.19; p < .0001) than individually (leukocytes OR: 1.38; CI 95% 1.00-1.64, p = .042; sTWEAK OR: 1.00; C I95% 1.00-1.01, p = .019). These results were validated using a second cohort, where leukocytes and sTWEAK showed a sensitivity of 100% and specificity of 66.7% and 75% respectively. CONCLUSIONS Leukocyte and sTWEAK could be biomarkers of reperfusion failure and subsequent poor outcomes. Further studies will be necessary to explore its role in reperfusion processes.
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Affiliation(s)
- Pablo Hervella
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Ana Sampedro-Viana
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | | | - Iria López-Dequidt
- Stroke Unit, Department of Neurology, Hospital Clínico Universitario, A Coruña, Spain
| | - José M Pumar
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Antonio J Mosqueira
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
- Department of Neuroradiology, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Sabela Fernández-Rodicio
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Marcos Bazarra-Barreiros
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Joaquín Serena
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Yolanda Silva-Blas
- Cerebrovascular Pathology Research Group, Stroke Unit, Department of Neurology, Hospital Universitari Dr. Josep Trueta de Girona, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Carme Gubern-Merida
- Cerebrovascular Pathology Research Group, Girona Biomedical Research Institute (IDIBGI), Parc Hospitalari Martí I Julià, Salt, Spain
| | - Daniel Rey-Aldana
- Centro de Salud de A Estrada, Area Sanitaria de Santiago de Compostela, A Estrada, Spain
| | - Sergio Cinza
- Centro de Saúde O Milladoiro, Santiago de Compostela, Spain
| | - Francisco Campos
- Translational Stroke Laboratory (TREAT), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Tomás Sobrino
- NeuroAging Laboratory Group (NEURAL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - José Castillo
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Maria Luz Alonso-Alonso
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
| | - Ramón Iglesias-Rey
- Neuroimaging and Biotechnology Laboratory (NOBEL), Clinical Neurosciences Research Laboratory (LINC), Health Research Institute of Santiago de Compostela (IDIS), A Coruña, Spain
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Macía M, Díaz-Encarnación M, Solans-Laqué R, Mallol EP, Castells AG, Escribano C, de Arellano AR. A projected cost-utility analysis of avacopan for the treatment of antineutrophil cytoplasmic antibody-associated vasculitis in Spain. Expert Rev Pharmacoecon Outcomes Res 2024; 24:227-235. [PMID: 38126738 DOI: 10.1080/14737167.2023.2297790] [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: 10/27/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are rare autoimmune diseases characterized by inflammation of blood vessels. This study aimed to assess the cost-utility of avacopan in combination with rituximab (RTX) or cyclophosphamide (CYC) compared with glucocorticoids (GC) for the treatment of severe, active AAV in Spain. METHODS A 9-state Markov model was designed to reflect the induction of remission and sustained remission of AAV over a lifetime horizon. Clinical data and utility values were mainly obtained from the ADVOCATE trial, and costs (€ 2022) were sourced from national databases. Quality-adjusted life years (QALYs), and incremental cost-utility ratio (ICUR) were evaluated. An annual discount rate of 3% was applied. Sensitivity analyses were performed to examine the robustness of the results. RESULTS Avacopan yielded an increase in effectiveness (6.52 vs. 6.17 QALYs) and costs (€16,009) compared to GC, resulting in an ICUR of €45,638 per additional QALY gained. Avacopan was associated with a lower incidence of end-stage renal disease (ESRD), relapse and hospitalization-related adverse events. Sensitivity analyses suggested that the model outputs were robust and that the progression to ESRD was a driver of ICUR. CONCLUSIONS Avacopan is a cost-effective option for patients with severe, active AAV compared to GC in Spain.
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Affiliation(s)
- Manuel Macía
- Nephrology Service, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Roser Solans-Laqué
- Internal Medicine Department, Hospital Valle de Hebrón, Barcelona, Spain
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Ramamoorthy V, Chan K, Roy M, Saxena A, Ahmed MA, Zhang Z, Appunni S, Thomas R, McGranaghan P, McDermott M, La Rosa FDLR, Rubens M. Healthcare expenditure trends among adult stroke patients in the United States, 2011-2020. J Stroke Cerebrovasc Dis 2023; 32:107333. [PMID: 37659191 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107333] [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: 02/28/2023] [Revised: 08/12/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023] Open
Abstract
BACKGROUND In the US, between 2018 and 2019, approximately $57 billion were expended on stroke and related conditions. The aim of this study was to understand trends in direct healthcare expenditures among stroke patients using novel cost estimation methods and a nationally representative database. METHODS This study was a retrospective analysis of 193,003 adults, ≥18 years of age, using the Medical Expenditure Panel Survey during 2009-2016. Manning and Mullahy's two-part model were used to calculate adjusted mean and incremental medical expenditures after adjusting for covariates. RESULTS The mean (Standard Deviation) direct annual healthcare expenditure among stroke patients was $16,979.0 ($16,222.0- $17,736.0) and was nearly 3 times greater than non-stroke participants which were $5,039.7 ($4,951.0-$5,128.5) and were mainly spent on inpatient services, prescription medications, and office-based visits. Stroke patients had an additional healthcare expenditure of $4096.0 (3543.9, 4648.1) per person per year, compared to participants without stroke after adjusting for covariates (P<0.001). The total mean annual direct healthcare expenditure for stroke survivors increased from $16,142.0 (15,017.0-17,267.0) in 2007-2008 to $16,979.0 (16,222.0-17,736.0) in 2015-2016. CONCLUSION Our study showed that stroke survivors had significantly greater healthcare expenses, compared to non-stroke individuals, mainly due to higher expenditures on inpatient services, prescription drugs, and office visits. These findings are concerning because the prevalence of stroke is projected to increase due to aging population and increased survival rates.
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Affiliation(s)
| | - Kelvin Chan
- Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Mukesh Roy
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA
| | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, FL 33176, USA
| | | | | | - Peter McGranaghan
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Michael McDermott
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Felipe De Los Rios La Rosa
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Baptist Health South Florida, Miami Neuroscience Institute, Miami, Florida 33176, USA
| | - Muni Rubens
- Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA; Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA; Universidad Espíritu Santo, Ecuador.
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Walsan R, Mitchell RJ, Braithwaite J, Westbrook J, Hibbert P, Mumford V, Harrison R. Is there an association between out-of-pocket hospital costs, quality and care outcomes? A systematic review of contemporary evidence. BMC Health Serv Res 2023; 23:984. [PMID: 37705006 PMCID: PMC10500869 DOI: 10.1186/s12913-023-09941-3] [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: 02/08/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Out of pocket (OOP) costs vary substantially by health condition, procedure, provider, and service location. Evidence of whether this variation is associated with indicators of healthcare quality and/or health outcomes is lacking. METHODS The current review aimed to explore whether higher OOP costs translate into better healthcare quality and outcomes for patients in inpatient settings. The review also aimed to identify the population and contextual-level determinants of inpatient out-of-pocket costs. A systematic electronic search of five databases: Scopus, Medline, Psych Info, CINAHL and Embase was conducted between January 2000 to October 2022. Study procedures and reporting complied with PRISMA guidelines. The protocol is available at PROSPERO (CRD42022320763). FINDINGS A total of nine studies were included in the final review. A variety of quality and health outcomes were examined in the included studies across a range of patient groups and specialities. The scant evidence available and substantial heterogeneity created challenges in establishing the nature of association between OOP costs and healthcare quality and outcomes. Nonetheless, the most consistent finding was no significant association between OOP cost and inpatient quality of care and outcomes. INTERPRETATION The review findings overall suggest no beneficial effect of higher OOP costs on inpatient quality of care and health outcomes. Further work is needed to elucidate the determinants of OOP hospital costs. FUNDING This study was funded by Medibank Better Health Foundation.
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Affiliation(s)
- Ramya Walsan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Rebecca J Mitchell
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Johanna Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
| | - Peter Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Virginia Mumford
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW, 2109, Australia
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Parody-Rua E, Bustamante A, Montaner J, Rubio-Valera M, Serrano D, Pérez-Sánchez S, Sánchez-Viñas A, Guevara-Cuellar C, Serrano-Blanco A. Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:621-632. [PMID: 35896861 PMCID: PMC10175459 DOI: 10.1007/s10198-022-01495-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 06/21/2022] [Indexed: 05/12/2023]
Abstract
OBJECTIVES Stroke treatment with intravenous tissue-type plasminogen activator (tPA) is effective and efficient, but as its benefits are highly time dependent, it is essential to treat the patient promptly after symptom onset. This study evaluates the cost-effectiveness of a blood biomarker test to differentiate ischemic and hemorrhagic stroke to guide pre-hospital treatment with tPA in patients with suspected stroke, compared with standard hospital management. The standard care for patients suffering stroke consists mainly in diagnosis, treatment, hospitalization and monitoring. METHODS A Markov model was built with four health states according to the modified Rankin scale, in adult patients with suspected moderate to severe stroke (NIHSS 4-22) within 4.5 hours after symptom onset. A Spanish Health System perspective was used. The time horizon was 15 years. Quality-adjusted life-years (QALYs) and life-years gained (LYGs) were used as a measure of effectiveness. Short- and long-term direct health costs were included. Costs were expressed in Euros (2022). A discount rate of 3% was used. Probabilistic sensitivity analysis and several one-way sensitivity analyses were conducted. RESULTS The use of a blood-test biomarker compared with standard care was associated with more QALYs (4.87 vs. 4.77), more LYGs (7.18 vs. 7.07), and greater costs (12,807€ vs. 12,713€). The ICER was 881€/QALY. Probabilistic sensitivity analysis showed that the biomarker test was cost-effective in 82% of iterations using a threshold of 24,000€/QALY. CONCLUSIONS The use of a blood biomarker test to guide pre-hospital thrombolysis is cost-effective compared with standard hospital care in patients with ischemic stroke.
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Affiliation(s)
- Elizabeth Parody-Rua
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain
| | | | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville and Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Maria Rubio-Valera
- Head of Quality and Patient Safety, Parc Sanitari Sant Joan de Déu. Institut de Recerca Sant Joan de Déu, Sant Boi de Llobregat, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Soledad Pérez-Sánchez
- Institute de Biomedicine of Seville, IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville and Department of Neurology, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Alba Sánchez-Viñas
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | | | - Antoni Serrano-Blanco
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Parc Sanitari Sant Joan de Déu. Institut de Recerca Sant Joan de Déu, Mental Health Directorate, C/Camí Vell de la Colònia, 25, 08830, Sant Boi de Llobregat, Barcelona, Spain.
- Departament de Medicina. Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain.
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9
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Reverté-Villarroya S, Suñer-Soler R, Sauras-Colón E, Zaragoza-Brunet J, Fernández-Sáez J, Lopez-Espuela F. [Ischemic stroke and vascular risk factors in young and older adults. Community-based retrospective study (2011-2020)]. Aten Primaria 2023; 55:102623. [PMID: 37086593 PMCID: PMC10148073 DOI: 10.1016/j.aprim.2023.102623] [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: 12/10/2022] [Revised: 03/10/2023] [Accepted: 03/20/2023] [Indexed: 04/24/2023] Open
Abstract
OBJECTIVE To analyze the presence of vascular risk factors (VRF) among young adult and older adult patients with ischemic stroke, with and without follow-up in primary care after hospital discharge. DESIGN Observational, retrospective, multicenter study. SETTING Primary care health centers and Hospital Verge de la Cinta, Tortosa, Spain. PARTICIPANTS Patients with ischemic stroke of two age groups (≤55 and ≥65years) distributed in two groups (GroupA: without follow-up in primary care; and GroupB: with follow-up in primary care), between 2011-2020. MAIN MEASUREMENTS Sociodemographic, clinical, and VRF data coded according to the International Classification of Diseases (ICD-10). Descriptive, and inferential statistics. RESULTS Data from 2054 participants were analyzed. In the young adult group, 94.9% of the participants in groupA had between 1-2VRFs, compared to 60% in groupB. In the older adult group, 84.4% of groupA had between 1-2VRFs, compared to 43,9% of groupB. The most frequent VRFs among younger and older adult patients with ischemic stroke were hypertension and dyslipidemia in both follow-up groups. There were no records of obesity, smoking, or alcohol consumption in groupA. There was a significant association between being followed up in primary care after stroke and being a young adult and presenting between 3-4 VRFs (P<0.001). CONCLUSIONS The results reinforce the need for continuity of care and follow-up in people with acute stroke in primary care and the need to improve the quality of registries.
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Affiliation(s)
- Silvia Reverté-Villarroya
- Departamento de Enfermería, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, España; Grupo de Investigación Avanzada en Enfermería, Universitat Rovira i Virgili, Tarragona, España
| | - Rosa Suñer-Soler
- Grupo de Investigación Salud y Atención Sanitaria, Facultad de Enfermería, Universidad de Girona, Girona, España.
| | - Esther Sauras-Colón
- Hospital de Tortosa Verge de la Cinta, Unidad de Estudios Clínicos, Institut d'Investigació Sanitària Pere i Virgili, Tortosa, Tarragona, España
| | - Josep Zaragoza-Brunet
- Hospital de Tortosa Verge de la Cinta, Unidad de Estudios Clínicos, Institut d'Investigació Sanitària Pere i Virgili, Tortosa, Tarragona, España
| | - José Fernández-Sáez
- Departamento de Enfermería, Campus Terres de l'Ebre, Universitat Rovira i Virgili, Tortosa, Tarragona, España; Unitat de Support a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Tortosa, Tarragona, España
| | - Fidel Lopez-Espuela
- Grupo de Investigación en Enfermedades Metabólicas Óseas, Departamento de Enfermería, Universidad de Extremadura, Cáceres, España; Facultad de Enfermería y Terapia Ocupacional, Universidad de Extremadura, Cáceres, España
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10
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Application of Robotic Recovery Techniques to Stroke Survivors-Bibliometric Analysis. J Pers Med 2022; 12:jpm12122066. [PMID: 36556286 PMCID: PMC9788322 DOI: 10.3390/jpm12122066] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Stroke is a significant disability and death cause worldwide and is conventionally defined as a neurological impairment relating to the intense focal harm of the central nervous system (CNS) by vascular causative components. Although the applicability of robotic rehabilitation is a topic with considerable practical significance because it has produced noticeably higher improvements in motor function than regular (physical and occupational) therapy and exempted the therapists, most of the existing bibliometric papers were not focused on stroke survivors. Additionally, a modular system is designed by joining several medical end-effector devices to a single limb segment, which addresses the issue of potentially dangerous pathological compensatory motions. Searching the Web of Science database, 31,930 papers were identified, and using the VOSviewer software and science mapping technology, data were extracted on the most prolific countries, the connections between them, the most valuable journals according to certain factors, their average year of publication, the most influential papers, and the most relevant topical issues (bubble map of term occurrence). The most prolific country in the analyzed field and over the entire period evaluated (1975-2022) is the United States, and the most prolific journal is Neurorehabilitation and Neural Repair, observing a marked increase in the three periods of scientific interest for this field. The present paper assesses numerous scientific publications to provide, through statistical interpretation of the data, a detailed description of the use of robotic rehabilitation in stroke survivors. The findings may aid scientists, academics, and clinicians in establishing precise goals in the optimization of the management of stroke survivors via robotic rehabilitation, but also through easier access to scientifically validated literature.
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11
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Ipinnimo TM, Adewoye KR, Durowade KA, Elegbede OE, Ojo JO, Dele-Ojo BF, Oluwademilade OJ, Atoyebi OA, Sanni TA, Asake OT, Daramola BW, Fadipe AO. Comparative assessment of health-related quality of life among hypertensive patients attending state and federal government teaching hospitals in Ekiti State, Nigeria. DIALOGUES IN HEALTH 2022; 1:100069. [PMID: 38515920 PMCID: PMC10953898 DOI: 10.1016/j.dialog.2022.100069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/29/2022] [Accepted: 10/30/2022] [Indexed: 03/23/2024]
Abstract
Background Hypertension is a serious health problem and it is one of the diseases that impair health-related quality of life. The central tenet of care should be to improve health-related quality of life and overall well-being and not just be limited to improving clinical outcomes. This study assesses and compares health-related quality of life and its predictors among hypertensive patients in two government hospitals in Ekiti State, Nigeria. Methods This was a comparative cross-sectional study involving 440 hypertensive patients (220 in each group), recruited using a systematic sampling technique within the hospitals. Data on socio-demographic, economic and clinical characteristics including the cost of care for hypertension were collected from the patients. The WHOQoL-BREF questionnaire was used to assess health-related quality of life. Data were entered and analyzed using IBM SPSS Statistics for Windows, Version 22.0. Results All domains of health-related quality of life were better among patients in federal government teaching hospitals, however, only the physical (T = -7.932, p < 0.001) and overall (T = -2.783, p = 0.006) domains were of statistical significance. An inverse relationship between cost and health-related quality of life was found in the two hospitals (State: r = -0.224, p = 0.001; Federal: r = -0.378, p < 0.001). Identified predictors of health-related quality of life were age, locality of residence, income, number of complications, exercise and smoking in both hospitals. Other predictors were marital status, living arrangement, occupation, number of medications, and involvement in religious and spiritual activities among patients in the state government teaching hospital; household size, length of diagnosis, and indirect cost among patients in the federal government teaching hospital. Conclusion There is a need to support hypertensive patients in the state government teaching hospitals to reduce the inequality of low health-related quality of life among them. Identified predictors should be taken into consideration when putting in place policies that will improve the health-related quality of life of these patients.
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Affiliation(s)
| | - Kayode Rasaq Adewoye
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - Kabir Adekunle Durowade
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - Olusegun Elijah Elegbede
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | - John Olujide Ojo
- Department of Community Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Community Medicine, Afe Babalola University, Ado Ekiti, Nigeria
| | | | - Olarinde Jeffrey Oluwademilade
- Department of Medicine, Federal Teaching Hospital, Ido-Ekiti, Nigeria
- Department of Medicine, Afe Babalola University, Ado-Ekiti, Nigeria
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12
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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; 19:11110. [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.
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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
| | - 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
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13
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Garay OU, Guiñazú G, Adamczuk YP, Duboscq C. Cost-Utility and Budget Impact Analysis of Implementing Anticoagulation Clinics and Point-of-Care Monitoring Devices in Anticoagulated Patients in Argentina. PHARMACOECONOMICS - OPEN 2022; 6:657-668. [PMID: 35835938 PMCID: PMC9440177 DOI: 10.1007/s41669-022-00352-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Worldwide, 1 % of the population receives anticoagulation therapy, with prevalence higher in older adults. Difficulties in the adequate management of these patients have led to the development of strategies focused on achieving therapeutic control and reducing adverse events with efficient use of resources. OBJECTIVE To estimate the cost utility and budget impact on the Argentinean health system of implementation of anticoagulation clinics (ACs) (with and without use of point-of-care [POC] CoaguChek® devices [Roche Diagnostics International Ltd]) compared with the traditional laboratory method (non-AC settings) for the management of anticoagulated patients. METHODS For the cost-utility analysis, a cohort-based state transition model was designed to compare costs and health outcomes of implementing ACs for outpatient management of anticoagulated patients. The budget impact analysis used an analytical model to estimate the differential costs of implementing an AC and the expected adverse events avoided, and the differential costs of an international normalized ratio (INR) determination using a POC device rather than a conventional laboratory. RESULTS We calculated the study outcomes for a cohort of 1000 patients. Considering a 5 % discount rate, the use of ACs generated 13.9 additional quality-adjusted life-years (0.014 per patient) and 12.5 additional life-years (0.013 per patient). Incremental cost-effectiveness ratios of AC implementation with and without the use of POC devices compared with the scenario without ACs were dominant in both cases. In the probabilistic sensitivity analysis, nearly all simulated results were cost effective (i.e., below the 1 or 3 gross domestic product per capita thresholds). Budget impact analysis results showed AC implementation generated savings from the first year of implementation, with savings of AR $265,325 by year 5. The addition of POC devices in the ACs also generated savings as early as the first year of implementation, with savings of AR $488,072 by year 5 (AR $488 per patient). CONCLUSIONS Anticoagulation clinics are estimated to be cost effective and generate notable savings in the treatment of patients on long-term oral anticoagulant therapy when compared with non-AC settings. These savings are considerably higher when POC devices are added as part of the patient management, due to lower laboratory technician costs per INR determination.
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Affiliation(s)
| | - Gonzalo Guiñazú
- Roche Diagnostics Argentina, Rawson 3150 B1610BAL-Ricardo Rojas, Tigre, Buenos Aires, Argentina.
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14
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Salgueiro C, Urrútia G, Cabanas-Valdés R. Telerehabilitation for balance rehabilitation in the subacute stage of stroke: A pilot controlled trial. NeuroRehabilitation 2022; 51:91-99. [PMID: 35311721 DOI: 10.3233/nre-210332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Telerehabilitation has been proposed as an effective strategy to deliver post-stroke specific exercise. OBJECTIVE To assess the effectiveness and feasibility of core stability exercises guided by a telerehabilitation App after hospital discharge. METHODS Extension of a prospective controlled trial. Subacute stage stroke survivors were included at the time of hospital discharge where they had participated in a previous 5-week randomized controlled trial comparing conventional physiotherapy versus core stability exercises. After discharge, patients from the experimental group were offered access to telerehabilitation to perform core stability exercises at home (AppG), while those from the control group were subject to usual care (CG). The Spanish-version of the Trunk Impairment Scale 2.0 (S-TIS 2.0), Function in Sitting Test (S-FIST), Berg Balance Scale (BBS), Spanish-version of Postural Assessment for Stroke Patients (S-PASS), the number of falls, Brunel Balance Assessment (BBA) and Gait were assessed before and after 3 months intervention. RESULTS A total of 49 subjects were recruited. AppG showed greater improvement in balance in both sitting and standing position and gait compared with CG, although no statistically significant differences were obtained. CONCLUSION Core stability exercises Telerehabilitation as a home-based guide appears to improve balance in post-stroke stage. Future studies are necessary to confirm the effects as well as identifying strategies to increase telerehabilitation adherence.
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Affiliation(s)
- Carina Salgueiro
- Health Science PHD program, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gerard Urrútia
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBERESP, Madrid, Spain
| | - Rosa Cabanas-Valdés
- Department of Physiotherapy, Faculty of Medicine and Health Science, Universitat Internacional de Catalunya, Sant Cugat del Valles, Barcelona, Spain
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15
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Lobo EH, Abdelrazek M, Grundy J, Kensing F, Livingston PM, Rasmussen LJ, Islam SMS, Frølich A. Caregiver Engagement in Stroke Care: Opportunities and Challenges in Australia and Denmark. Front Public Health 2021; 9:758808. [PMID: 34900907 PMCID: PMC8661098 DOI: 10.3389/fpubh.2021.758808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/04/2021] [Indexed: 01/01/2023] Open
Abstract
Globally, there is a rise in incident cases of stroke, particularly in low- and middle-income countries, due to obesity-related and lifestyle risk factors, including health issues such as high cholesterol, diabetes and hypertension. Since the early 20th century, stroke mortality has declined due to proper management of the risk factors and improved treatment practices. However, despite the decline in mortality, there is an increase in the levels of disability that requires long-term support. In countries such as Australia and Denmark, where most care is provided within the community; family members, generally spouses, assume the role of caregiver, with little to no preparation that affects the quality of care provided to the person living with stroke. While past research has highlighted aspects to improve caregiver preparedness of stroke and its impact on care; health planning, recovery, and public health policies rarely consider these factors, reducing engagement and increasing uncertainty. Hence, there is a need to focus on improving strategies during recovery to promote caregiver engagement. In this study, we, therefore, try to understand the needs of the caregiver in stroke that limit engagement, and processes employed in countries such as Australia and Denmark to provide care for the person with stroke. Based on our understanding of these factors, we highlight the potential opportunities and challenges to promote caregiving engagement in these countries.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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Fang Q, Shang D, Zhang Y, Geng X, Liu F, Zhang Q, Wang X. Will the zero-margin drug policy reduce the economic burden of stroke patients in China? J Glob Health 2021; 11:08007. [PMID: 34671464 PMCID: PMC8501452 DOI: 10.7189/jogh.11.08007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background China is facing a more severe stroke challenge. In 2017, China fully implemented the zero-margin drug policy (ZMDP), cancelling 15% of drug markups in public hospitals. Based on the “System of Health Accounts 2011” (SHA 2011), this paper explores the changes in the economic burden of stroke in China after implementing ZMDP to provide an accurate reference for policymakers. Methods Stroke patients from 2016 to 2018 were selected by multistage stratification probability-proportional random sampling in Shanxi Province. A total of 223 187 samples were included. Regression discontinuity design (RDD) was used to measure the change of drug proportion and cost. Sensitivity analysis and subgroup analysis were implied to determine the stability of the results. Results The current curative expenditure on stroke from 2016 to 2018 was 4374.69, 3727.22, and 3752.52 million Chinese Yuan (CNY). About 90% of the cost occurred during hospitalization, and 60% in general hospitals. After the implementation of ZMDP, the drug proportion from 46.54% (interquartile range (IQR) = 37.10%, 55.14%) in 2016 to 36.40% (IQR = 25.82%, 48.58%) in 2018, and average hospitalization cost per stay was from 7950.02 (IQR = 4938.76, 12 639.90) CNY in 2016 to 7362.08 (IQR = 4892.82, 11 501.40) CNY in 2018. RDD showed the drug proportion decreased by 2.76% (95% confidence interval (CI) = 1.17%, 4.35%, P = 0.001), and the expense decreased by 4698.34 (95% CI = 3047.59, 6349.09, P < 0.001) CNY. Conclusions The economic burden of stroke patients in China was severe. ZMDP played a noticeable effect in reducing drug proportion and hospitalization costs. The Chinese government should continue to implement relevant policies to control stroke costs according to regional and population characteristics.
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Affiliation(s)
- Quan Fang
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Degao Shang
- Liaoning Province Center for Disease Control and Prevention, Shenyang, Liaoning, China
| | - Yunxia Zhang
- Institute for Shanxi Medical Institution Administration, Taiyuan, Shanxi, China
| | - Xinli Geng
- Institute for Shanxi Medical Institution Administration, Taiyuan, Shanxi, China
| | - Fang Liu
- College of Health Management, China Medical University, Shenyang, Liaoning, China
| | - Qin Zhang
- College of Health Management, China Medical University, Shenyang, Liaoning, China.,Shengjing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xin Wang
- College of Health Management, China Medical University, Shenyang, Liaoning, China.,Research Center for Health Development - Liaoning New Type Think Tank for University, Shenyang, Liaoning, China
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Strilciuc S, Grad DA, Radu C, Chira D, Stan A, Ungureanu M, Gheorghe A, Muresanu FD. The economic burden of stroke: a systematic review of cost of illness studies. J Med Life 2021; 14:606-619. [PMID: 35027963 PMCID: PMC8742896 DOI: 10.25122/jml-2021-0361] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 01/02/2023] Open
Abstract
Stroke is one of the leading causes of morbidity and mortality worldwide. As the number of stroke cases is rising from one year to another, policymakers require data on the amount spent on stroke to enforce better financing policies for prevention, hospital care, outpatient rehabilitation services and social services. We aimed to systematically assess the economic burden of stroke at global level. Cost of stroke studies were retrieved from five databases. We retrieved the average cost per patient, where specified, or estimated it using a top-down approach. Resulting costs were grouped in two main categories: per patient per year and per patient lifetime. We extracted information from forty-six cost of illness studies. Per patient per year costs are larger in high income countries and in studies conducted from the payer perspective. The highest average per patient per year cost by country was reported in the United States ($59,900), followed by Sweden ($52,725) and Spain ($41,950). The highest per patient lifetime costs were reported in Australia ($232,100) for all identified definitions of stroke. Existing literature regarding the economic burden of stroke is concentrated in high-income settings, with very few studies conducted in South America and Africa. Published manuscripts on this topic highlight substantial methodological heterogeneity, rendering comparisons difficult or impossible, even within the same country or among studies with similar costing perspectives.
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Affiliation(s)
- Stefan Strilciuc
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Diana Alecsandra Grad
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Constantin Radu
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Diana Chira
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Adina Stan
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Marius Ungureanu
- Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Adrian Gheorghe
- Department of Infectious Disease Epidemiology, Global Health and Development Group, Imperial College London, London, United Kingdom
| | - Fior-Dafin Muresanu
- Department of Neuroscience, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
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Diferencias de género en la calidad de vida a largo plazo tras un ictus: influencia del estado funcional y el estado de ánimo. Neurologia 2020; 35:470-478. [DOI: 10.1016/j.nrl.2017.10.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022] Open
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López Espuela F, Portilla Cuenca J, Leno Díaz C, Párraga Sánchez J, Gamez-Leyva G, Casado Naranjo I. Sex differences in long-term quality of life after stroke: influence of mood and functional status. NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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20
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Capel M, Ciudin A, Mareque M, Rodríguez-Rincón RM, Simón S, Oyagüez I. Cost-Effectiveness Analysis of Exenatide versus GLP-1 Receptor Agonists in Patients with Type 2 Diabetes Mellitus. PHARMACOECONOMICS - OPEN 2020; 4:277-286. [PMID: 31338828 PMCID: PMC7248155 DOI: 10.1007/s41669-019-0171-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study was to assess the efficiency of exenatide 2 mg/week compared with other glucagon-like peptide-1 (GLP-1) receptor agonists (dulaglutide 1.5 mg/week, liraglutide 1.2 mg/day, liraglutide 1.8 mg/day and lixisenatide 20 μg/day) in adult patients with type 2 diabetes mellitus (T2DM) not adequately controlled on metformin alone from the perspective of the Spanish National Health System (NHS). METHODS Quality-adjusted life-years (QALYs) gained and total costs of each assessed drug combined with metformin (2 g/day) were estimated over a 40-year time horizon using the Cardiff Diabetes Model (based on UK Prospective Diabetes Study [UKPDS] 68 equations), which simulates disease progression considering the T2DM-related micro- and macrovascular complications, hypoglycaemia, nausea, body mass index (BMI) changes and treatment discontinuation due to adverse effects (AEs). Drug efficacy derived from an indirect comparison performed in a network meta-analysis. Patient characteristics were obtained from the literature. The baseline utility value (0.80) was derived from the PANORAMA study, applying utility decrements to micro- and macrovascular complications, hypoglycaemia episodes and changes in BMI. Treatment discontinuation due to AEs or poorly controlled diabetes (HbA1c > 7.5%) involved switching to second-line (basal insulin) or third-line (basal-bolus insulin) treatment. Total cost (€, 2018) included the costs of drug acquisition, hypoglycaemia, weight gain, micro- and macrovascular complications, nausea and treatment discontinuation due to AEs. An annual discount rate of 3% was applied to costs and outcomes. Deterministic and probabilistic sensitivity analyses (SA) were performed. RESULTS In base-case, exenatide 2 mg/week resulted in more QALYs (8.26) than dulaglutide 1.5 mg/week (8.19 QALYs), liraglutide 1.2 mg/day (8.10 QALYs), liraglutide 1.8 mg/day (8.20 QALYs) and lixisenatide 20 μg/day (8.13 QALYs). Total cost/patient was €20,423.27 (exenatide 2 mg/week), €22,611.94 (dulaglutide 1.5 mg/week), €21,065.97 (liraglutide 1.2 mg/day), €24,865.69 (liraglutide 1.8 mg/day) and €21,334.58 (lixisenatide 20 μg/day). Deterministic SA confirmed the robustness of the model. In the probabilistic SA, 95-99% of the 1000 Monte Carlo iterations performed were under a hypothetical willingness-to-pay threshold of €20,000/QALY gained. CONCLUSIONS Exenatide 2 mg/week would be a dominant strategy (more effective and less costly) versus the other GLP-1 receptor agonists assessed for the treatment of T2DM patients who are not adequately controlled on metformin alone.
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Affiliation(s)
| | | | - María Mareque
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain.
| | | | | | - Itziar Oyagüez
- Pharmacoeconomics and Outcomes Research Iberia (PORIB), Paseo Joaquín Rodrigo 4-I, Pozuelo de Alarcón, 28224, Madrid, Spain
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Willems R, Pil L, Lambrinou CP, Kivelä J, Wikström K, Gonzalez-Gil EM, De Miguel-Etayo P, Nánási A, Semánová C, Van Stappen V, Cardon G, Tsochev K, Iotova V, Chakarova N, Makrilakis K, Dafoulas G, Timpel P, Schwarz P, Manios Y, Annemans L. Methodology of the health economic evaluation of the Feel4Diabetes-study. BMC Endocr Disord 2020; 20:14. [PMID: 32164685 PMCID: PMC7066818 DOI: 10.1186/s12902-019-0471-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 12/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The clinical and economic burden of type 2 diabetes mellitus on society is rising. Effective and efficient preventive measures may stop the increasing prevalence, given that type 2 diabetes mellitus is mainly a lifestyle-driven disease. The Feel4Diabetes-study aimed to tackle unhealthy lifestyle (unhealthy diet, lack of physical activity, sedentary behaviour, and excess weight) of families with a child in the first grades of elementary school. These schools were located in regions with a relatively low socio-economic status in Belgium, Bulgaria, Finland, Greece, Hungary and Spain. Special attention was paid to families with a high risk of developing type 2 diabetes mellitus. METHODS The aim of this paper is to describe the detailed methodology of the intervention's cost-effectiveness analysis. Based on the health economic evaluation of the Toybox-study, both a decision analytic part and a Markov model have been designed to assess the long-term (time horizon of 70 year with one-year cycles) intervention's value for money. Data sources used for the calculation of health state incidences, transition probabilities between health states, health state costs, and health state utilities are listed. Intervention-related costs were collected by questionnaires and diaries, and attributed to either all families or high risk families only. CONCLUSIONS The optimal use of limited resources is pivotal. The future results of the health economic evaluation of the Feel4Diabetes-study will contribute to the efficient use of those resources.
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Affiliation(s)
- Ruben Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
| | - Lore Pil
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
| | - Christina-Paulina Lambrinou
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Jemina Kivelä
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie 166, 00271 Helsinki, Finland
| | - Esther M. Gonzalez-Gil
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Institute of Nutrition and Food Technology, Center of Biomedical Research, University of Granada, Granada, Spain
| | - Pilar De Miguel-Etayo
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, University of Zaragoza, 50009 Zaragoza, Spain
- Instituto Agroalimentario de Aragon (IA2), Zaragoza, Spain
- Instituto de Investigacion Sanitaria Aragón (IIS Aragon), University of Zaragoza, Zaragoza, Spain
- Centro de Investigacion Biomedica en Red de Fisiopatologia de la Obesidad y Nutricion (CIBERObn), University of Zaragoza, Zaragoza, Spain
| | - Anna Nánási
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, 400 Hungary
| | - Csilla Semánová
- Department of Family and Occupational Medicine, University of Debrecen, Debrecen, 400 Hungary
| | - Vicky Van Stappen
- Department of Movement and Sports Sciences, Ghent University, Campus Dunant, Watersportlaan 2, 9000 Ghent, Belgium
| | - Greet Cardon
- Department of Movement and Sports Sciences, Ghent University, Campus Dunant, Watersportlaan 2, 9000 Ghent, Belgium
| | - Kaloyan Tsochev
- Department of Paediatrics, Medical University Varna, 1 Hr. Smirnenski Blvd, 9010 Varna, Bulgaria
| | - Violeta Iotova
- Department of Paediatrics, Medical University Varna, 1 Hr. Smirnenski Blvd, 9010 Varna, Bulgaria
| | - Nevena Chakarova
- Department of Diabetology, Clinical Center of Endocrinology, Medical University Sofia, Sofia, Bulgaria
| | | | - George Dafoulas
- National and Kapodistrian University of Athens, 17 Ag. Thoma St, 11527 Athens, Greece
| | - Patrick Timpel
- Department for Precention and Care of Diabetes, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
| | - Peter Schwarz
- Department for Precention and Care of Diabetes, Technische Universität Dresden, Fetscherstraße 74, 01307 Dresden, Germany
- Paul Langerhans Institute Dresden of the Helmholtz Center Munich at University Hospital and Faculty of Medicine, Technische Universitat Dresden, Dresden, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Yannis Manios
- Department of Nutrition and Dietetics, Harokopio University, 70 El Venizelou Ave, 176 71 Kallithea, Athens, Greece
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Entrance 42 – Floor 4, 9000 Ghent, Belgium
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Girotra T, Lekoubou A, Bishu KG, Ovbiagele B. A contemporary and comprehensive analysis of the costs of stroke in the United States. J Neurol Sci 2020; 410:116643. [DOI: 10.1016/j.jns.2019.116643] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 10/25/2022]
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Abdul Aziz AF, Mohd Nordin NA, Muhd Nur A, Sulong S, Aljunid SM. The integrated care pathway for managing post stroke patients (iCaPPS ©) in public primary care Healthcentres in Malaysia: impact on quality adjusted life years (QALYs) and cost effectiveness analysis. BMC Geriatr 2020; 20:70. [PMID: 32070291 PMCID: PMC7029527 DOI: 10.1186/s12877-020-1453-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 01/28/2020] [Indexed: 11/25/2022] Open
Abstract
Background The delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. Primary care teams are entrusted to provide longer term care for stroke survivors in most developing countries. The integrated Care Pathway for Post Stroke patients (iCaPPS©) was designed to guide primary care teams to incorporate further rehabilitation and regular screening for post stroke complications among patients residing at home in communities, using the shared-care approach, especially in areas with limited access to specialist stroke care services. The iCaPPS© addressed coordination of rehabilitation and screening for post stroke complications which were absent in the current conventional care of patients managed at public primary care healthcentres. This study aimed to evaluate the cost effectiveness and impact of iCaPPS© on quality-adjusted- life-years (QALY) compared with current conventional monitoring at public primary care healthcentres. Methods A pragmatic healthcentre-based cluster randomised controlled trial-within trial on 151 post stroke patients from 10 public primary care facilities in Peninsular Malaysia was conducted to evaluate QALY of patients managed with iCaPPS© (n = 86) vs conventional care (n = 65) for 6 months. Costs from societal perspective were calculated, using combination of top down and activity-based costing methods. The 5-level EQ5D (EQ-5D-5 L) was used to calculate health state utility scores. Cost per QALY and incremental cost effectiveness ratio (ICER) were determined. Differences within groups were determined using Mann-Whitney tests. Results Total costs for 6 months treatment with iCaPPS© was MYR790.34, while conventional care cost MYR527.22. Median QALY for iCaPPS© was 0.55 (0,1.65) compared to conventional care 0.32 (0, 0.73) (z = − 0.21, p = 0.84). Cost per QALY for iCaPPS© was MYR1436.98, conventional care was MYR1647.56. The ICER was MYR1144.00, equivalent to 3.7% of per capita GDP (2012 prices). Conclusions Management of post stroke patients in the community using iCaPPS© costs less per QALY compared to current conventional care and is very cost effective. Trial registration Trial Registration number ACTRN12616001322426. Registered 21 September 2016. (Retrospectively registered).
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Affiliation(s)
- Aznida Firzah Abdul Aziz
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Level 14, Preclinical Block, Jalan Yaacob Latiff, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia.
| | - Nor Azlin Mohd Nordin
- Center for Rehabilitation and Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Amrizal Muhd Nur
- International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Health Policy & Management, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Saperi Sulong
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.,Department of Health Policy & Management, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
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Edwards SJ, Wakefield V, Jhita T, Kew K, Cain P, Marceniuk G. Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke: a systematic review and economic evaluation. Health Technol Assess 2020; 24:1-184. [PMID: 31944175 PMCID: PMC6983910 DOI: 10.3310/hta24050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cryptogenic stroke is a stroke for which no cause is identified after standard diagnostic tests. Long-term implantable cardiac monitors may be better at diagnosing atrial fibrillation and provide an opportunity to reduce the risk of stroke recurrence with anticoagulants. OBJECTIVES The objectives were to assess the diagnostic test accuracy, clinical effectiveness and cost-effectiveness of three implantable monitors [BioMonitor 2-AF™ (Biotronik SE & Co. KG, Berlin, Germany), Confirm Rx™ (Abbott Laboratories, Lake Bluff, IL, USA) and Reveal LINQ™ (Medtronic plc, Minneapolis, MN, USA)] in patients who have had a cryptogenic stroke and for whom no atrial fibrillation is detected after 24 hours of external electrocardiographic monitoring. DATA SOURCES MEDLINE, EMBASE, The Cochrane Library, Database of Abstracts of Reviews of Effects and Health Technology Assessment databases were searched from inception until September 2018. REVIEW METHODS A systematic review was undertaken. Two reviewers agreed on studies for inclusion and performed quality assessment using the Cochrane Risk of Bias 2.0 tool. Results were discussed narratively because there were insufficient data for synthesis. A two-stage de novo economic model was developed: (1) a short-term patient flow model to identify cryptogenic stroke patients who have had atrial fibrillation detected and been prescribed anticoagulation treatment (rather than remaining on antiplatelet treatment) and (2) a long-term Markov model that captured the lifetime costs and benefits of patients on either anticoagulation or antiplatelet treatment. RESULTS One randomised controlled trial, Cryptogenic Stroke and underlying Atrial Fibrillation (CRYSTAL-AF) (Sanna T, Diener HC, Passman RS, Di Lazzaro V, Bernstein RA, Morillo CA, et al. Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med 2014;370:2478-86), was identified, and no diagnostic test accuracy study was identified. The CRYSTAL-AF trial compared the Reveal™ XT (a Reveal LINQ predecessor) (Medtronic plc) monitor with standard of care monitoring. Twenty-six single-arm observational studies for the Reveal devices were also identified. The only data for BioMonitor 2-AF or Confirm Rx were from mixed population studies supplied by the companies. Atrial fibrillation detection in the CRYSTAL-AF trial was higher with the Reveal XT than with standard monitoring at all time points. By 36 months, atrial fibrillation was detected in 19% of patients with an implantable cardiac monitor and in 2.3% of patients receiving conventional follow-up. The 26 observational studies demonstrated that, even in a cryptogenic stroke population, atrial fibrillation detection rates are highly variable and most cases are asymptomatic; therefore, they probably would not have been picked up without an implantable cardiac monitor. Device-related adverse events, such as pain and infection, were low in all studies. The de novo economic model produced incremental cost effectiveness ratios comparing implantable cardiac monitors with standard of care monitoring to detect atrial fibrillation in cryptogenic stroke patients based on data for the Reveal XT device, which can be related to Reveal LINQ. The BioMonitor 2-AF and Confirm RX were included in the analysis by making a strong assumption of equivalence with Reveal LINQ. The results indicate that implantable cardiac monitors could be considered cost-effective at a £20,000-30,000 threshold. When each device is compared incrementally, BioMonitor 2-AF dominates Reveal LINQ and Confirm RX. LIMITATIONS The cost-effectiveness analysis for implantable cardiac monitors is based on a strong assumption of clinical equivalence and should be interpreted with caution. CONCLUSIONS All three implantable cardiac monitors could be considered cost-effective at a £20,000-30,000 threshold, compared with standard of care monitoring, for cryptogenic stroke patients with no atrial fibrillation detected after 24 hours of external electrocardiographic monitoring; however, further clinical studies are required to confirm their efficacy in cryptogenic stroke patients. STUDY REGISTRATION This study is registered as PROSPERO CRD42018109216. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Steven J Edwards
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | | | - Tracey Jhita
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | - Kayleigh Kew
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | - Peter Cain
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
| | - Gemma Marceniuk
- British Medical Journal (BMJ) Technology Assessment Group, London, UK
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Valcárcel-Nazco C, Alonso-Modino D, Montón-Álvarez F, Sabatel-Hernández R, Pastor-Santoveña M, Mesa-Blanco P, López-Fernández J, Serrano-Aguilar P. Variability in the use of neuroimaging techniques for diagnosis and follow-up of stroke patients. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Grandes variaciones en la utilización de pruebas por imagen en el diagnóstico y seguimiento de los pacientes con ictus. Neurologia 2019; 34:360-366. [DOI: 10.1016/j.nrl.2017.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 11/21/2022] Open
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Lekuona I, Anguita M, Zamorano JL, Rodríguez JM, Barja de Soroa P, Pérez-Alcántara F. ¿El uso de edoxabán sería coste-efectivo para la prevención del ictus y la embolia sistémica en pacientes con fibrilación auricular no valvular en España? Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2018.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tyagi S, Koh GCH, Nan L, Tan KB, Hoenig H, Matchar DB, Yoong J, Finkelstein EA, Lee KE, Venketasubramanian N, Menon E, Chan KM, De Silva DA, Yap P, Tan BY, Chew E, Young SH, Ng YS, Tu TM, Ang YH, Kong KH, Singh R, Merchant RA, Chang HM, Yeo TT, Ning C, Cheong A, Ng YL, Tan CS. Healthcare utilization and cost trajectories post-stroke: role of caregiver and stroke factors. BMC Health Serv Res 2018; 18:881. [PMID: 30466417 PMCID: PMC6251229 DOI: 10.1186/s12913-018-3696-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is essential to study post-stroke healthcare utilization trajectories from a stroke patient caregiver dyadic perspective to improve healthcare delivery, practices and eventually improve long-term outcomes for stroke patients. However, literature addressing this area is currently limited. Addressing this gap, our study described the trajectory of healthcare service utilization by stroke patients and associated costs over 1-year post-stroke and examined the association with caregiver identity and clinical stroke factors. METHODS Patient and caregiver variables were obtained from a prospective cohort, while healthcare data was obtained from the national claims database. Generalized estimating equation approach was used to get the population average estimates of healthcare utilization and cost trend across 4 quarters post-stroke. RESULTS Five hundred ninety-two stroke patient and caregiver dyads were available for current analysis. The highest utilization occurred in the first quarter post-stroke across all service types and decreased with time. The incidence rate ratio (IRR) of hospitalization decreased by 51, 40, 11 and 1% for patients having spouse, sibling, child and others as caregivers respectively when compared with not having a caregiver (p = 0.017). Disability level modified the specialist outpatient clinic usage trajectory with increasing difference between mildly and severely disabled sub-groups across quarters. Stroke type and severity modified the primary care cost trajectory with expected cost estimates differing across second to fourth quarters for moderately-severe ischemic (IRR: 1.67, 1.74, 1.64; p = 0.003), moderately-severe non-ischemic (IRR: 1.61, 3.15, 2.44; p = 0.001) and severe non-ischemic (IRR: 2.18, 4.92, 4.77; p = 0.032) subgroups respectively, compared to first quarter. CONCLUSION Highlighting the quarterly variations, we reported distinct utilization trajectories across subgroups based on clinical characteristics. Caregiver availability reducing hospitalization supports revisiting caregiver's role as potential hidden workforce, incentivizing their efforts by designing socially inclusive bundled payment models for post-acute stroke care and adopting family-centered clinical care practices.
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Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Luo Nan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham VA Medical Centre, Durham, USA
| | - David B. Matchar
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Eric A. Finkelstein
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Kim En Lee
- Lee Kim En Neurology Pte Ltd, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew’s Community Hospital, Singapore, Singapore
| | | | - Deidre Anne De Silva
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | | | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, Singapore, Singapore
| | - Sherry H. Young
- Department of Rehabilitation Medicine, Changi General Hospital, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Keng Hee Kong
- Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Rajinder Singh
- Department of Neurology, National Neuroscience Institute, Neurology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Reshma A. Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, Singapore General Hospital campus, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Chou Ning
- Department of Neurosurgery, National University Hospital, Singapore, Singapore
| | - Angela Cheong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
| | - Yu Li Ng
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549 Singapore
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Cost-effectiveness analysis of sensor-augmented pump therapy with low glucose-suspend in patients with type 1 diabetes mellitus and high risk of hypoglycemia in Spain. ENDOCRINOL DIAB NUTR 2018; 65:380-386. [DOI: 10.1016/j.endinu.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/19/2018] [Accepted: 03/20/2018] [Indexed: 11/20/2022]
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Lekuona I, Anguita M, Zamorano JL, Rodríguez JM, Barja de Soroa P, Pérez-Alcántara F. Would the Use of Edoxaban Be Cost-effective for the Prevention of Stroke and Systemic Embolism in Patients With Nonvalvular Atrial Fibrillation in Spain? ACTA ACUST UNITED AC 2018; 72:398-406. [PMID: 31007166 DOI: 10.1016/j.rec.2018.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 03/23/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES To assess the cost-effectiveness of edoxaban vs acenocoumarol in the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF) in Spain. METHODS Markov model, adapted to the Spanish setting from the perspective of the National Health System, stimulating the progression of a hypothetical cohort of patients with NVAF throughout their lifetime, with different health states: stroke, haemorrhage, and other cardiovascular complications. Efficacy and safety data were obtained from the available clinical evidence (mainly from the phase III ENGAGE AF-TIMI 48 study). The costs of managing NVAF and its complications were obtained from Spanish sources. RESULTS Edoxaban use led to 0.34 additional quality-adjusted life years (QALY) compared with acenocoumarol. The incremental cost with edoxaban was 3916€, mainly because of higher pharmacological costs, which were partially offset by lower costs of treatment monitoring and managing NVAF events and complications. The cost per QALY was 11 518€, within the thresholds commonly considered cost-effective in Spain (25 000-30 000 €/QALY). The robustness of the results was confirmed by various sensitivity analyses. CONCLUSIONS Edoxaban is a cost-effective alternative to acenocoumarol in the prevention of stroke and systemic embolism in patients with NVAF in Spain.
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Affiliation(s)
- Iñaki Lekuona
- Servicio de Cardiología, Hospital de Galdakao, Usansolo, Vizcaya, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Reina Sofía, Córdoba, Spain
| | - José Luis Zamorano
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Oliva-Moreno J, Peña-Longobardo LM, Mar J, Masjuan J, Soulard S, Gonzalez-Rojas N, Becerra V, Casado MÁ, Torres C, Yebenes M, Quintana M, Alvarez-Sabín J. Determinants of Informal Care, Burden, and Risk of Burnout in Caregivers of Stroke Survivors. Stroke 2018; 49:140-146. [DOI: 10.1161/strokeaha.117.017575] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 10/19/2017] [Accepted: 10/23/2017] [Indexed: 12/26/2022]
Abstract
Background and Purpose—
The aim of this article was to analyze the likelihood of receiving informal care after a stroke and to study the burden and risk of burnout of primary caregivers in Spain.
Methods—
The CONOCES study is an epidemiological, observational, prospective, multicenter study of patients diagnosed with stroke and admitted to a Stroke Unit in the Spanish healthcare system. At 3 and 12 months post-event, we estimated the time spent caring for the patient and the burden borne by primary caregivers. Several multivariate models were applied to estimate the likelihood of receiving informal caregiving, the burden, and the likelihood of caregivers being at a high risk of burnout.
Results—
Eighty percent of those still alive at 3 and 12 months poststroke were receiving informal care. More than 40% of those receiving care needed a secondary caregiver at 3 months poststroke. The likelihood of receiving informal care was associated with stroke severity and the individual’s health-related quality of life. When informal care was provided, both the burden borne by caregivers and the likelihood of caregivers being at a high risk of burnout was associated with (1) caregiving hours; (2) the patient’s health-related quality of life; (3) the severity of the stroke measured at discharge; (4) the patient having atrial fibrillation; and (5) the degree of dependence.
Conclusions—
This study reveals the heavy burden borne by the caregivers of stroke survivors. Our analysis also identifies explanatory and predictive variables for the likelihood of receiving informal care, caregiver burden, and high risk of burnout.
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Affiliation(s)
- Juan Oliva-Moreno
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Luz María Peña-Longobardo
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Javier Mar
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Jaime Masjuan
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Stéphane Soulard
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Nuria Gonzalez-Rojas
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Virginia Becerra
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Miguel Ángel Casado
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Covadonga Torres
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - María Yebenes
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Manuel Quintana
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
| | - Jose Alvarez-Sabín
- From the Department of Economic Analysis, Universidad de Castilla-La Mancha, Toledo, Spain (J.O.-M., L.M.P.-L.); Clinical Management Service, Alto Deba Hospital, Mondragon, Spain (J. Mar); Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain (J. Masjuan); Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain (S.S., N.G.-R., V.B.); Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain (M.Á.C., C.T., M.Y
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Chabowski M, Grzebien A, Ziomek A, Dorobisz K, Leśniak M, Janczak D. Quality of life after carotid endarterectomy: a review of the literature. Acta Neurol Belg 2017. [PMID: 28639143 PMCID: PMC5670192 DOI: 10.1007/s13760-017-0811-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Strokes are one of the leading causes of death, morbidity, and disability worldwide, mainly among elderly people. It is also the third most common cause of years of life being lost, indicating a high risk of premature mortality. Revascularisation with endarterectomy (CEA) is effective in reducing the risk of death and strokes in patients with carotid artery stenosis, but the effect of invasive treatment on quality of life (QoL) still needs attention. To shed more light on the patients’ perspective on this health condition, we carried out a review of the literature which aimed to analyze the level of health-related QoL among stroke survivors, with special attention to patients who had been treated with CEA. Strokes significantly reduce the level of QoL, which may subsequently be improved in the course of treatment with CEA. Patients experience a reduced level of QoL in the early postoperative period, but at 1 year following CEA, the level of QoL remains stable and is similar to that of chronically ill patients. The domains of QoL which are most affected are physical and emotional functioning, which also serve as markers for decreased QoL in the long term. Older age and comorbidities are predictors of worse QoL. Stroke survivors require proper care both immediately after a stroke happens and during the long-term rehabilitation. Measurement of QoL and of the determining factors that contribute to a reduced level of QoL, as well as focusing on determinants of QoL in stroke survivors may help to reduce patients’ disability and improve their daily functioning in society as well as reducing the cost of health care.
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Affiliation(s)
- Mariusz Chabowski
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland.
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981, Wroclaw, Poland.
| | - Anna Grzebien
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
- Department of General and Vascular Surgery, Research and Development Centre, Voivodship Specialist Hospital in Wroclaw, Wroclaw, Poland
| | - Agnieszka Ziomek
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981, Wroclaw, Poland
| | - Karolina Dorobisz
- Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, 213 Borowska Street, 50-556, Wroclaw, Poland
| | - Michał Leśniak
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981, Wroclaw, Poland
| | - Dariusz Janczak
- Division of Surgical Specialties, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618, Wroclaw, Poland
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981, Wroclaw, Poland
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Sanchez-Santos R, Padin EM, Adam D, Borisenko O, Fernandez SE, Dacosta EC, Fernández SG, Vazquez JT, de Adana JCR, de la Cruz Vigo F. Bariatric surgery versus conservative management for morbidly obese patients in Spain: a cost-effectiveness analysis. Expert Rev Pharmacoecon Outcomes Res 2017; 18:305-314. [PMID: 29188745 DOI: 10.1080/14737167.2018.1407649] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND We assessed the cost-effectiveness of bariatric surgery (BS) versus conservative management (CM) for treating morbid obesity in Spain. METHODS We developed a probabilistic Markov model to estimate health outcomes, quality-adjusted life years (QALY), life years gained (LYG), and costs over lifetime and 10-year horizons. Combined common BS procedures were compared with CM. Clinical and utility inputs were obtained from the literature and resource use and costs from local sources (€2017). RESULTS Over the 10-year horizon, BS led to a cost increment of €9,386 and 1.6 additional QALY (€5,966/QALY). Leading to 0.6 LYG and 4.4 QALY gains and €300/patient average cost savings over lifetime, BS could potentially significantly reduce diabetes and cardiovascular disease risk over the considered horizons. Despite short-term cost reductions, surgery delay may lead to significant clinical benefits loss. CONCLUSIONS Compared to CM, BS is a more effective and less costly alternative for treating morbid obesity in Spain.
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Affiliation(s)
- Raquel Sanchez-Santos
- a General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra, Instituto de Investigación Galicia Sur , Pontevedra , Spain
| | - Esther Mariño Padin
- b General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra , Pontevedra , Spain
| | - Daniel Adam
- c Health Economics Department , Synergus AB , Danderyd , Sweden
| | - Oleg Borisenko
- c Health Economics Department , Synergus AB , Danderyd , Sweden
| | - Sergio Estevez Fernandez
- d General and Digestive Surgery Department , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Ester Carrera Dacosta
- d General and Digestive Surgery Department , Complejo Hospitalario Universitario de Pontevedra , Pontevedra , Spain
| | - Sonia González Fernández
- b General and Digestive Surgery Department , Complejo Hospitalario de Pontevedra , Pontevedra , Spain
| | - Juan Turnes Vazquez
- e Digestive System Department , Instituo de investigación Galicia Sur , Pontevedra , Spain
| | | | - Felipe de la Cruz Vigo
- g General and Digestive Surgery Department , Hospital Universitario 12 de Octubre , Madrid , Spain
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Matsumoto K, Hanaoka S, Wu Y, Hasegawa T. Comprehensive Cost of Illness of Three Major Diseases in Japan. J Stroke Cerebrovasc Dis 2017; 26:1934-1940. [DOI: 10.1016/j.jstrokecerebrovasdis.2017.06.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/07/2017] [Accepted: 06/09/2017] [Indexed: 11/30/2022] Open
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36
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Health-related quality of life in Spanish informal caregivers: gender differences and support received. Qual Life Res 2017; 26:3227-3238. [DOI: 10.1007/s11136-017-1678-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 10/19/2022]
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Ahmad RS, Hussain MB, Saeed F, Waheed M, Tufail T. Phytochemistry, metabolism, and ethnomedical scenario of honey: A concurrent review. INTERNATIONAL JOURNAL OF FOOD PROPERTIES 2017. [DOI: 10.1080/10942912.2017.1295257] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Rabia Shabir Ahmad
- Institute of Home and Food Sciences, Government College University, Faisalabad, Pakistan
| | - Muhammad Bilal Hussain
- Institute of Home and Food Sciences, Government College University, Faisalabad, Pakistan
| | - Farhan Saeed
- Institute of Home and Food Sciences, Government College University, Faisalabad, Pakistan
| | - Marwa Waheed
- Institute of Home and Food Sciences, Government College University, Faisalabad, Pakistan
| | - Tabussam Tufail
- Institute of Home and Food Sciences, Government College University, Faisalabad, Pakistan
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Alvarez-Sabín J, Quintana M, Masjuan J, Oliva-Moreno J, Mar J, Gonzalez-Rojas N, Becerra V, Torres C, Yebenes M. Economic impact of patients admitted to stroke units in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2017; 18:449-458. [PMID: 27084749 DOI: 10.1007/s10198-016-0799-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/31/2016] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Stroke is a major social and health problem. However, since the recent incorporation of new advances in its management, little is known about the cost of stroke. The aim of this study is to find out the real cost of stroke in Spain. METHODS This is an epidemiological, observational, prospective, multicenter study of patients diagnosed with stroke and admitted to a stroke unit. Patients were recruited from 16 hospitals throughout Spain and followed up for 1 year. Sociodemographic, clinical, and economic data were collected. Costs (€ 2012) were estimated from the social perspective and were divided into direct healthcare (inpatient, outpatient, and medication), direct non-healthcare (mainly formal and informal care) and labor productivity losses. RESULTS A total of 321 patients were included. Mean age was 72.1 years and 176 patients (54.8 %) were male. Total average cost per patient/year was €27,711. Direct healthcare costs amounted to €8491 per patient/year (68.8 % due to inpatient costs) and non-healthcare costs to an average of €18,643 per patient/year (89.5 % due to informal care). Productivity loss costs per patient/year were €276. Total costs of hemorrhagic strokes were slightly higher than ischemic (€28,895 vs. €27,569 per patient/year, p = 0.550) without significant differences. The main variables associated with higher costs were the presence of hypertension (€30,332 vs. €23,234 per patient/year, p < 0.05) and the severity of stroke (p < 0.05), both independently associated after a multivariate analysis. CONCLUSIONS The cost of patients admitted to stroke units in Spain is €27,711 per patient/year. More than two-thirds are social costs, mainly informal care. Stroke remains a major burden on health systems and society, so additional efforts are needed for its prevention.
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Affiliation(s)
- Jose Alvarez-Sabín
- Servei de Neurologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Manuel Quintana
- Servei de Neurologia, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Jaime Masjuan
- Stroke Unit, Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain
| | - Juan Oliva-Moreno
- Department of Economic Analysis, Universidad de Castilla La Mancha and REDISSEC, Toledo, Spain
| | - Javier Mar
- Clinical Management Service, Hospital Alto Deba, Mondragon, Spain
| | - Nuria Gonzalez-Rojas
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain
| | - Virginia Becerra
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain
| | | | - María Yebenes
- Pharmacoeconomics and Outcomes Research Iberia, Madrid, Spain
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Liotta G, Orfila F, Vollenbroek-Hutten M, Roller-Winsberger R, Illario M, Musian D, Alvino S, O’Caoimh R, Cano A, Molloy W, Iaccarino G, Marazzi MC, Inzerilli MC, Madaro O, Paul C, Csonka P, Vince AC, Menditto E, Maggio M, Scarcella P, Gilardi F, Lucaroni F, Abete P, Girardi V, Barra R, Palombi L. The European Innovation Partnership on Active and Healthy Ageing Synergies: Protocol for a Prospective Observational Study to Measure the Impact of a Community-Based Program on Prevention and Mitigation of Frailty (ICP - PMF) in Community-Dwelling Older Adults. Transl Med UniSa 2016; 15:53-66. [PMID: 27896228 PMCID: PMC5120751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim of this paper is to describe the protocol of the study "Impact of a Community-based Program on Prevention and Mitigation of Frailty in community-dwelling older adults" developed in the framework of the European Innovation Partnership on Active and Healthy Ageing. This proposal has been developed by the Partnership Action groups on frailty, fall prevention and polypharmacy in older. The proposal wants to assess the impact of community-based programs aimed to counteract three main outcomes related to frailty: hospitalization, institutionalization and death. Bringing together researchers from seven European countries, the proposal aims to achieve the critical mass and the geographical extension enough to provide information useful to all older European citizens. An observational study will be carried out to calculate the incidence of the different outcomes in relation to the various interventions that will be assessed; results will be compared with data coming from already established national, regional and local dataset using the observed/expected approach. The sample will be made up by at least 2000 citizens for each outcome. All the citizens will be assessed at the baseline with two multidimensional questionnaires: the RISC questionnaire and the Short Functional Geriatric Evaluation questionnaire. The outcomes will be assessed every six-twelve months.
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Affiliation(s)
- G Liotta
- Corresponding Author: Giuseppe Liotta; e-mail:
| | - F Orfila
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - M Vollenbroek-Hutten
- Faculty of Electrical Engineering, Mathematics and Computer Science, Telemedicine group, University of Twente, Enschede, The Netherlands
- Ziekenhuis Groep Twente, Almelo, The Netherlands
| | | | - M Illario
- DISMET, Federico II University Naples, Italy
| | | | | | - R O’Caoimh
- Health Research Board, Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - A Cano
- Department of Pediatrics, Obstetrics and Gynecology, University of Valencia, Spain
| | - W Molloy
- Centre for Gerontology and Rehabilitation, University College Cork, St Finbarrs Hospital, Cork City, Ireland
| | - G Iaccarino
- Department of Medicine, University of Salerno, Baronissi, Salerno
| | | | - MC Inzerilli
- Community of Sant’Egidio - Long Live the Elderly program, Rome Italy
- Rome Municipality, Italy
| | - O Madaro
- Community of Sant’Egidio - Long Live the Elderly program, Rome Italy
| | - C Paul
- ICBAS, University of Porto, Portugal
| | - P Csonka
- Educators’ Centre Association, Pecs, Hungary
| | - AC Vince
- Educators’ Centre Association, Pecs, Hungary
| | - E Menditto
- CIRFF, Center of Pharmacoeconomics, University of Naples Federico II 17University of Parma, Italy
| | - M Maggio
- University-Hospital of Parma, Emilia Romagna Region Italy
| | - P Scarcella
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
| | - F Gilardi
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
| | - F Lucaroni
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
| | - P Abete
- Medical University of Graz, Austria
| | - V Girardi
- Associazione Salute in Collina, Naples, Italy
| | - R Barra
- Associazione Salute in Collina, Naples, Italy
| | - L Palombi
- Biomedicine and Prevention Dept. – University of Rome Tor Vergata, Rome, Italy
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Long-Term Treatment with Citicoline Prevents Cognitive Decline and Predicts a Better Quality of Life after a First Ischemic Stroke. Int J Mol Sci 2016; 17:390. [PMID: 26999113 PMCID: PMC4813246 DOI: 10.3390/ijms17030390] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/02/2022] Open
Abstract
Stroke, as the leading cause of physical disability and cognitive impairment, has a very significant impact on patients’ quality of life (QoL). The objective of this study is to know the effect of citicoline treatment in Qol and cognitive performance in the long-term in patients with a first ischemic stroke. This is an open-label, randomized, parallel study of citicoline vs. usual treatment. All subjects were selected 6 weeks after suffering a first ischemic stroke and randomized into parallel arms. Neuropsychological evaluation was performed at 1 month, 6 months, 1 year and 2 years after stroke, and QoL was measured using the EuroQoL-5D questionnaire at 2 years. 163 patients were followed during 2 years. The mean age was 67.5 years-old, and 50.9% were women. Age and absence of citicoline treatment were independent predictors of both utility and poor quality of life. Patients with cognitive impairment had a poorer QoL at 2 years (0.55 vs. 0.66 in utility, p = 0.015). Citicoline treatment improved significantly cognitive status during follow-up (p = 0.005). In conclusion, treatment with long-term citicoline is associated with a better QoL and improves cognitive status 2 years after a first ischemic stroke.
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López-Espuela F, Pedrera-Zamorano JD, Jiménez-Caballero PE, Ramírez-Moreno JM, Portilla-Cuenca JC, Lavado-García JM, Casado-Naranjo I. Functional Status and Disability in Patients After Acute Stroke: A Longitudinal Study. Am J Crit Care 2016; 25:144-51. [PMID: 26932916 DOI: 10.4037/ajcc2016215] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Stroke is a major public health problem. OBJECTIVE To use the Barthel Index to evaluate basic activities of daily living in stroke survivors and detect any predictors of functional outcome at 6 months after stroke. METHODS In an observational longitudinal study, data were gathered on consecutive patients admitted to the comprehensive stroke unit at Hospital San Pedro de Alcantara, Cáceres, Spain. Sociodemographic and clinical data were obtained prospectively at hospital admission and during follow-up 6 months later. Information on type of stroke, score on the Barthel Index, findings from the neurological evaluation, and other relevant data were collected. RESULTS Of 236 patients admitted, 175 participated in the study. Mean age was 69.60 (SD, 12.52) years, 64.6% were men, and mortality was 12.8%. Six months after experiencing a stroke, 84.8% of patients had returned to their own homes, 8.0% were institutionalized, and the others were residing at a family member's home. Scores on the Barthel Index 6 months after stroke correlated with baseline scores on the National Institute of Health Stroke Scale (r = -0.424; P < .001) and with depressive mood 6 months after stroke (r = -0.318; P < .001). Age was negatively associated with Barthel Index scores at the time of hospital discharge and 6 months after stroke. CONCLUSIONS Functional status 6 months after stroke was influenced by age, sex, stroke severity, type of stroke, baseline status, mood, and social risk. Comorbid conditions, socioeconomic level, and area of residence did not affect patients' functional status.
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Affiliation(s)
- Fidel López-Espuela
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
| | - Juan Diego Pedrera-Zamorano
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
| | - Pedro Enrique Jiménez-Caballero
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
| | - José María Ramírez-Moreno
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
| | - Juan Carlos Portilla-Cuenca
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
| | - Jesús María Lavado-García
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
| | - Ignacio Casado-Naranjo
- Fidel López-Espuela is research nurse, Juan Diego Pedrera-Zamorano is head of the nursing department, Pedro Enrique Jiménez-Caballero, José María Ramírez-Moreno, and Juan Carlos Portilla-Cuenca are neurologists, Jesús María Lavado-García is vice dean of the nursing school, and Ignacio Casado-Naranjo is head of the department of neurology, Stroke Unit, Hospital San Pedro de Alcantara, Cáceres, Spain
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Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Jennum P, Iversen HK, Ibsen R, Kjellberg J. Cost of stroke: a controlled national study evaluating societal effects on patients and their partners. BMC Health Serv Res 2015; 15:466. [PMID: 26464109 PMCID: PMC4604706 DOI: 10.1186/s12913-015-1100-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 09/22/2015] [Indexed: 11/12/2022] Open
Abstract
Background To estimate the direct and indirect costs of stroke in patients and their partners. Description Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients and compared with 364,433, 103,741 and 500,490 matched controls, respectively. Results Independent of age and gender, stroke patients had significantly higher rates of mortality, health-related contacts, medication use and lower employment, lower income and higher social-transfer payments than controls. The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls for hemorrhagic, ischemic and unspecified stroke, respectively. The negative social- and health-related status could be identified up to eleven years before the first diagnosis. Conclusion Stroke has significant mortality, morbidity and socioeconomic consequences for patients, their partners and society.
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Affiliation(s)
- Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, DK 2600, Copenhagen, Glostrup, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
| | - Helle K Iversen
- Stroke Unit, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
| | - Rikke Ibsen
- 2minds, Klosterport 4E, 4, Aarhus, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
| | - Jakob Kjellberg
- Stroke Unit, Department of Neurology, Faculty of Health Sciences, University of Copenhagen, Glostrup Hospital, Copenhagen, Denmark. .,Danish Institute for Health Services Research, Copenhagen, Denmark.
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Ng CS, Toh MPHS, Ng J, Ko Y. Direct medical cost of stroke in Singapore. Int J Stroke 2015; 10 Suppl A100:75-82. [PMID: 26179153 DOI: 10.1111/ijs.12576] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 06/01/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. AIMS To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. METHODS The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. RESULTS A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001). CONCLUSION There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.
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Affiliation(s)
- Charmaine Shuyu Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Matthias Paul Han Sim Toh
- Information Management, Central Regional Health Office, National Healthcare Group, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Jiaying Ng
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore
| | - Yu Ko
- School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
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45
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Zhang H, Qian HZ, Meng SQ, Shu M, Gao YZ, Xu Y, Zhang SM, Hong M, Xiong RH. Psychological distress, social support and medication adherence in patients with ischemic stroke in the mainland of China. ACTA ACUST UNITED AC 2015; 35:405-410. [PMID: 26072081 DOI: 10.1007/s11596-015-1445-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 04/08/2015] [Indexed: 01/18/2023]
Abstract
Stroke research and rehabilitation have traditionally focused on the physical and functional impact of a stroke. Less attention has been given to the psychosocial factors associated with this chronic condition. By the few studies that have specifically focused on psychosocial factors in the context of stroke, poststroke depression is demonstrated to significantly influence stroke outcomes. Associations of stroke with psychological symptoms other than depression have rarely been evaluated. This study was aimed to investigate the changes of psychological stress, social support and medication adherence in patients with ischemic stroke in the mainland of China. In this study, 90 patients with hemiplegia one year after first-ever middle cerebral artery infarction (stroke group) in the Zhongnan Hospital of Wuhan University from June 2008 to June 2011 were recruited for interview. Ninety age- and sex-matched normal volunteers (control group) were also examined at the same period. The psychological distress was assessed by the Symptom Checklist 90 (SCL-90), the social support by the Social Support Rating Scale (SSRS), and medication adherence by Morisky's self-reported inventory, respectively. Group differences were analyzed using unpaired-t test and chi-squared test. The results showed that total mean scores of the SCL-90 in the stroke group were higher than those in the control group (P<0.01). Except two dimensions, paranoid ideation and psychoticism, mean scores of the rest dimensions (including somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, and phobic anxiety) of SCL-90 were significantly higher in the stroke group than those in the control group (P<0.05, or P<0.01). The objective support, subjective support, support availability and total social support scores in the stroke group were significantly higher than those in the control group (P<0.05, or P<0.01). Those in the "SCL-90 total scores >150 group" were significantly higher than in the "SCL-90 total scores <100 group" and the "SCL-90 total scores between 100 to 150 group" (P<0.05, or P<0.01). Those in the "SCL-90 total scores between 100 to 150 group" were significantly higher than in the "SCL-90 total scores <100 group" (P<0.05). In 90 patients with ischemic stroke, 26 (28.89%) patients obtained high medication adherence, 47 (52.22%) patients medium medication adherence, and 17 (18.89%) patients low medication adherence, respectively. Among these stroke patients, there were 17 (50.00%) patients with high medication adherence in the "SCL-90 total scores >150 group", 28 (75.67%) patients with medium medication adherence in the "SCL-90 total scores between 100 to 150 group", and 12 (61.16%) patients with low medication adherence in the "SCL-90 total scores <100 group", respectively. There was significant difference in the medication adherence rate among the different SCL-90 scores groups in these stroke patients (P<0.05 or P<0.01). It was led to conclude that ischemic stroke patients one year after hemiplegia have psychological distress, low level of social support and poor medication adherence in the mainland of China. Therefore, it is necessary to mobilize the government, medical institutions and various social support groups to offer psychological interventions to relieve the stress of patients with ischemic stroke, and improve their medication adherence.
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Affiliation(s)
- Hong Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China. .,Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Hai-Zhou Qian
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Shu-Qing Meng
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Min Shu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong-Zhe Gao
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yan Xu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Sheng-Ming Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.,Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Mei Hong
- Department of Internal Medicine, International Hospital of Mongolian Medicine, Huhehaote, 010065, China
| | - Rong-Hong Xiong
- Teaching and Research Section of Neuropsychiatry, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
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Chiumente M, Gianino MM, Minniti D, Mattei TJ, Spass B, Kamal KM, Zimmerman DE, Muca A, Luda E. Burden of stroke in Italy: an economic model highlights savings arising from reduced disability following thrombolysis. Int J Stroke 2015; 10:849-55. [PMID: 25854294 DOI: 10.1111/ijs.12481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The consequences of stroke must be assessed not only in terms of incidence and mortality rates, but also in terms of disability, which may persist long after the acute phase. Thrombolysis, if timely administered, can effectively reduce post-stroke disability. AIMS The economic model presented herein aims to evaluate, in eligible patients, the effects of alteplase on post-stroke disability and related costs over three-years. METHODS The economic analysis was developed on the basis of four key components: clinical outcomes from international trials, economic consequences extracted from cost of illness studies, regulatory data from national and international agencies, and national epidemiological data. A population-level model estimated the difference in disability costs between patients treated with standard care versus those receiving thrombolytic therapy within 4×5 h of acute ischemic stroke. The analysis covered 36 months from discharge. RESULTS Reduced costs related to post-stroke disability were observed in treated patients compared with those receiving standard care (control). The overall savings were €2330×15 per average patient: €1445×81 during the first 18 months, €362×25 between 18 and 24 months, and €522×09 in the 24-36 months period. The overall savings on 3174 Italian treated patients in 2013 were €7 395 907 over three-years. CONCLUSION Our study reveals that performing thrombolytic therapy in eligible patients improves economic outcomes compared with patients receiving standard care. This model is useful for decision makers, both within and outside of the Italian national context, as a tool to assess the cost-effectiveness of thrombolysis in both short- and long-term period.
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Affiliation(s)
- M Chiumente
- Post Graduate School of Hospital Pharmacy, University of Turin, Turin, TO, Italy
| | - M M Gianino
- Department of Public Health and Paediatrics Sciences, University of Turin, Turin, TO, Italy
| | - D Minniti
- Medical Direction, Rivoli Hospital, Rivoli, TO, Italy
| | - T J Mattei
- Division of Clinical, Social and Administrative Sciences, Duquesne University, Mylan School of Pharmacy, Duquesne, PA, USA
| | - B Spass
- Division of Neurology - The Hospital of Central Connecticut, New Britain, CT, USA
| | - K M Kamal
- Division of Clinical, Social and Administrative Sciences, Duquesne University, Mylan School of Pharmacy, Duquesne, PA, USA
| | - D E Zimmerman
- Division of Clinical, Social and Administrative Sciences, Duquesne University, Mylan School of Pharmacy, Duquesne, PA, USA
| | - A Muca
- Department of Public Health and Paediatrics Sciences, University of Turin, Turin, TO, Italy
| | - E Luda
- Neurology Department, Rivoli Hospital, Rivoli, TO, Italy
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Chaker L, Falla A, van der Lee SJ, Muka T, Imo D, Jaspers L, Colpani V, Mendis S, Chowdhury R, Bramer WM, Pazoki R, Franco OH. The global impact of non-communicable diseases on macro-economic productivity: a systematic review. Eur J Epidemiol 2015; 30:357-95. [PMID: 25837965 PMCID: PMC4457808 DOI: 10.1007/s10654-015-0026-5] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 03/24/2015] [Indexed: 12/23/2022]
Abstract
Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
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Affiliation(s)
- Layal Chaker
- Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Mar J, Masjuan J, Oliva-Moreno J, Gonzalez-Rojas N, Becerra V, Casado MÁ, Torres C, Yebenes M, Quintana M, Alvarez-Sabín J. Outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain. Health Qual Life Outcomes 2015; 13:36. [PMID: 25889480 PMCID: PMC4391532 DOI: 10.1186/s12955-015-0230-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/03/2015] [Indexed: 12/21/2022] Open
Abstract
Introduction The primary objective of this sub analysis of the CONOCES study was to analyse outcomes in terms of mortality rates, quality of life and degree of autonomy over the first year in patients admitted to stroke units in Spain. The secondary objective was to identify the factors determining good prognosis. Methods We studied a sample of patients who had suffered a confirmed stroke and been admitted to a Stroke Unit in the Spanish healthcare system. Socio-demographic and clinical variables and variables related to the level of severity (NIHSS), the level of autonomy (Barthel, modified Rankin) and quality of life (EQ-5D) were recorded at the time of admission and then three months and one year after the event. Factors determining prognosis were analysed using logistic regression and ROC curves. Results A total of 321 patients were recruited, 33% of whom received thrombolytic treatment, which was associated with better results on the Barthel and the modified Rankin scales and in terms of the risk of death. Mean quality of life measured through EQ-5D improved from 0.57 at discharge to 0.65 one year later. Full autonomy level measured by Barthel index increased from 30.1% at discharge to 52.8% at one year and by the modified Rankin scale from 51% to 71%. The rates for in-hospital and 1-year mortality were 5.9% and 17.4% respectively. Low NIHSS scores were associated with a good prognosis with all the outcome variables. The three instruments applied (NIHSS, Barthel and modified Rankin scales) on admission showed good discriminative ability for patient prognosis in the ROC curves. Conclusions There has been a change in the prognosis for stroke in Spain in recent years as the quality of life at 1 year observed in our study is clearly higher than that obtained in other Spanish studies conducted previously. Moreover, survival and functional outcome have also improved following the introduction of a new model of care. These results clearly promote extension of the model based on stroke units and reinforced rehabilitation to the majority of the more than 100,000 strokes that occur annually in Spain.
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Affiliation(s)
- Javier Mar
- Clinical Management Service, Alto Deba Hospital, Mondragon, Spain. .,Unidad de Gestión Sanitaria, Hospital 'Alto Deba', Avenida Navarra 16, 20500, Mondragón, Spain.
| | - Jaime Masjuan
- Stroke Unit, Neurology Department, Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Madrid, Spain.
| | - Juan Oliva-Moreno
- Department of Economic Analysis, Universidad de Castilla La Mancha and REDISSEC, Toledo, Spain.
| | - Nuria Gonzalez-Rojas
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain.
| | - Virginia Becerra
- Health Economics and Outcomes Research, Boehringer Ingelheim España, Barcelona, Spain.
| | | | | | - María Yebenes
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain.
| | - Manuel Quintana
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain.
| | - Jose Alvarez-Sabín
- Neurovascular Unit, Department of Neurology, Universitat Autònoma de Barcelona, Hospital Vall d'Hebron, Barcelona, Spain.
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López-Espuela F, González-Gil T, Jiménez-Gracia MA, Bravo-Fernández S, Amarilla-Donoso J. Impacto en la calidad de vida en cuidadores de supervivientes de un ictus. ENFERMERIA CLINICA 2015; 25:49-56. [DOI: 10.1016/j.enfcli.2014.12.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022]
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50
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The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol 2015; 30:251-77. [DOI: 10.1007/s10654-014-9984-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/23/2014] [Indexed: 12/11/2022]
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