2
|
Douglas V, Shamy M, Bhattacharya P. Should CT Angiography be a Routine Component of Acute Stroke Imaging? Neurohospitalist 2015; 5:97-8. [PMID: 26288667 DOI: 10.1177/1941874415588393] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vanja Douglas
- Department of Neurology, University of California, San Francisco, CA, USA
| | - Michel Shamy
- Department of Medicine (Neurology), University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
5
|
Rasura M, Baldereschi M, Di Carlo A, Di Lisi F, Patella R, Piccardi B, Polizzi B, Inzitari D. Effectiveness of public stroke educational interventions: a review. Eur J Neurol 2013; 21:11-20. [DOI: 10.1111/ene.12266] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 08/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M. Rasura
- UOS Stroke Unit; Azienda-Ospedaliera Sant'Andrea; Sapienza; University of Rome; Rome Italy
| | - M. Baldereschi
- Italian National Research Council; Neurosciences Institute; Florence Italy
| | - A. Di Carlo
- Italian National Research Council; Neurosciences Institute; Florence Italy
| | - F. Di Lisi
- UOS Stroke Unit; Azienda-Ospedaliera Sant'Andrea; Sapienza; University of Rome; Rome Italy
| | - R. Patella
- UOS Stroke Unit; Azienda-Ospedaliera Sant'Andrea; Sapienza; University of Rome; Rome Italy
| | - B. Piccardi
- Department of Neurosciences and Pharmacology; University of Florence; Florence Italy
| | - B. Polizzi
- Center of Disease Control; Health Ministry; Rome Italy
| | - D. Inzitari
- Department of Neurosciences and Pharmacology; University of Florence; Florence Italy
| | | |
Collapse
|
6
|
Marshall S, Fearon P, Dawson J, Quinn TJ. Stop the clots, but at what cost? Pharmacoeconomics of dabigatran etexilate for the prevention of stroke in subjects with atrial fibrillation: a systematic literature review. Expert Rev Pharmacoecon Outcomes Res 2013; 13:29-42. [PMID: 23402443 DOI: 10.1586/erp.12.79] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Dabigatran etexilate is a newly approved agent for prophylaxis of stroke in atrial fibrillation. Through narrative review, the authors assess evidence of the efficacy of dabigatran in stroke prevention, focusing on the multicenter, randomized trial RE-LY. The authors complement this with a review of the clinical efficacy of standard treatments (antiplatelet and warfarin). Finally, the authors present a systematic review of published studies describing the economics of dabigatran. Our systematic search gave six economic reviews from a variety of healthcare systems (the USA, Canada and the UK) and utilizing different economic models. Analyses suggest economic benefit of high- or sequential-dose dabigatran, particularly when stroke risk is high; intracerebral hemorrhage risk is high or warfarin control is poor. However, questions remain around dabigatran tolerability, compliance and possible unexpected adverse events.
Collapse
Affiliation(s)
- Sarah Marshall
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Walton Building, Glasgow Royal Infirmary, Glasgow G4 0SF, Scotland, UK
| | | | | | | |
Collapse
|
7
|
Krueger H, Lindsay P, Cote R, Kapral MK, Kaczorowski J, Hill MD. Cost Avoidance Associated With Optimal Stroke Care in Canada. Stroke 2012; 43:2198-206. [DOI: 10.1161/strokeaha.111.646091] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hans Krueger
- From the School of Population and Public Health (H.K.), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; H. Krueger & Associates Inc (H.K.), Delta, British Columbia, Canada; Canadian Stroke Network (P.L., M.K.K.), Ottawa, Ontario, Canada; the Institute of Health Policy, Management and Evaluation (P.L., M.K.K.) and the Department of Medicine (M.K.K.), University of Toronto, Toronto, Ontario, Canada; the Department of Neurology and Neurosurgery and Medicine
| | - Patrice Lindsay
- From the School of Population and Public Health (H.K.), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; H. Krueger & Associates Inc (H.K.), Delta, British Columbia, Canada; Canadian Stroke Network (P.L., M.K.K.), Ottawa, Ontario, Canada; the Institute of Health Policy, Management and Evaluation (P.L., M.K.K.) and the Department of Medicine (M.K.K.), University of Toronto, Toronto, Ontario, Canada; the Department of Neurology and Neurosurgery and Medicine
| | - Robert Cote
- From the School of Population and Public Health (H.K.), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; H. Krueger & Associates Inc (H.K.), Delta, British Columbia, Canada; Canadian Stroke Network (P.L., M.K.K.), Ottawa, Ontario, Canada; the Institute of Health Policy, Management and Evaluation (P.L., M.K.K.) and the Department of Medicine (M.K.K.), University of Toronto, Toronto, Ontario, Canada; the Department of Neurology and Neurosurgery and Medicine
| | - Moira K. Kapral
- From the School of Population and Public Health (H.K.), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; H. Krueger & Associates Inc (H.K.), Delta, British Columbia, Canada; Canadian Stroke Network (P.L., M.K.K.), Ottawa, Ontario, Canada; the Institute of Health Policy, Management and Evaluation (P.L., M.K.K.) and the Department of Medicine (M.K.K.), University of Toronto, Toronto, Ontario, Canada; the Department of Neurology and Neurosurgery and Medicine
| | - Janusz Kaczorowski
- From the School of Population and Public Health (H.K.), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; H. Krueger & Associates Inc (H.K.), Delta, British Columbia, Canada; Canadian Stroke Network (P.L., M.K.K.), Ottawa, Ontario, Canada; the Institute of Health Policy, Management and Evaluation (P.L., M.K.K.) and the Department of Medicine (M.K.K.), University of Toronto, Toronto, Ontario, Canada; the Department of Neurology and Neurosurgery and Medicine
| | - Michael D. Hill
- From the School of Population and Public Health (H.K.), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; H. Krueger & Associates Inc (H.K.), Delta, British Columbia, Canada; Canadian Stroke Network (P.L., M.K.K.), Ottawa, Ontario, Canada; the Institute of Health Policy, Management and Evaluation (P.L., M.K.K.) and the Department of Medicine (M.K.K.), University of Toronto, Toronto, Ontario, Canada; the Department of Neurology and Neurosurgery and Medicine
| |
Collapse
|
8
|
Quinn TJ, Dawson J. Novel lytics, novel imaging: a new treatment strategy in stroke? J Comp Eff Res 2012; 1:311-4. [PMID: 24237464 DOI: 10.2217/cer.12.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Intravenous thrombolysis with alteplase is one of the few evidence-based acute ischemic stroke treatments. Efficacy is time dependent and not all patients treated within the 4.5 h license derive benefit. The lytic agent tenecteplase has theoretical benefits. In the Phase II study by Parsons and colleagues, tenecteplase was superior to alteplase across imaging and safety outcomes for patients selected using specific imaging criteria. We review the evidence for thrombolysis, experience with tenecteplase and compare this study with others that have used similar designs for the investigation of novel stroke lytic agents.
Collapse
Affiliation(s)
- Terence J Quinn
- Institute of Cardiovascular & Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UK
| | | |
Collapse
|