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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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Lorenzano S, Ahmed N, Tatlisumak T, Gomis M, Dávalos A, Mikulik R, Sevcik P, Ollikainen J, Wahlgren N, Toni D. Within-Day and Weekly Variations of Thrombolysis in Acute Ischemic Stroke. Stroke 2014; 45:176-84. [DOI: 10.1161/strokeaha.113.002133] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Temporal variations of thrombolysis delivery and their influence on outcome have been reported with controversial results. In this large cohort study, we evaluated whether thrombolytic treatment has a within-day and weekly variability corresponding to circadian and weekly patterns of ischemic stroke onset, and whether these have impact on clinical outcome.
Methods—
We retrospectively analyzed patients with acute ischemic stroke receiving intravenous alteplase, prospectively included in the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Register. Patients were grouped by treatment on day hours (08:00–19:59) or night hours (20:00–07:59) and treatment on weekdays and weekends. For each subgroup, we analyzed frequency of thrombolytic treatments, time intervals, and outcomes (3-month modified Rankin Scale score 0–2 as good functional outcome, mortality, symptomatic intracerebral hemorrhage).
Results—
We included 21 513 patients. Considering the mean expected number of patients treated per hour (0.4) and per day of the week (9.8), if no temporal variations were present, patients were significantly treated more during day hours and weekdays (
P
<0.0001). Median door-to-needle and onset-to-treatment times were longer for patients treated during night hours and on weekends (
P
<0.01). After adjustment for confounding variables, treatment during day hours was an independent predictor of good functional outcome (odds ratio, 1.12; 95% confidence interval, 1.04–1.21;
P
=0.004), and patients treated during weekdays were at risk of higher mortality (odds ratio, 1.15; 95% confidence interval, 1.04–1.28;
P
=0.008).
Conclusions—
Frequency of thrombolytic treatment seems to follow the same circadian pattern of stroke incidence, whereas its correspondence to a weekly pattern is less clear. Time of treatment is an independent predictor of outcome.
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Affiliation(s)
- Svetlana Lorenzano
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Niaz Ahmed
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Turgut Tatlisumak
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Meritxell Gomis
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Antoni Dávalos
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Robert Mikulik
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Petr Sevcik
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Jyrki Ollikainen
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Nils Wahlgren
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
| | - Danilo Toni
- From the Emergency Department Stroke Unit, Department of Neurology and Psychiatry, Policlinico Umberto I Hospital, Sapienza University of Rome, Rome, Italy (S.L., D.T.); Karolinska Stroke Research Unit, Department of Neurology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden (N.A., N.W.); Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland (T.T.); Acute Stroke Unit, Department of Neuroscience, Hospital Universitari Germas Trias i Pujol,
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Chatterjee P, Cucchiara BL, Lazarciuc N, Shofer FS, Pines JM. Emergency Department Crowding and Time to Care in Patients With Acute Stroke. Stroke 2011; 42:1074-80. [DOI: 10.1161/strokeaha.110.586610] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pia Chatterjee
- From the State University of New York Downstate Medical Center/Kings County Hospital (P.C.), Brooklyn, NY; the Department of Neurology (B.L.C.), University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (N.L.), Hospital of the University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (F.S.S.), University of North Carolina, Durham, NC; and the Departments of Emergency Medicine and Health Policy (J.M.P.), George Washington University, Washington, DC
| | - Brett L. Cucchiara
- From the State University of New York Downstate Medical Center/Kings County Hospital (P.C.), Brooklyn, NY; the Department of Neurology (B.L.C.), University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (N.L.), Hospital of the University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (F.S.S.), University of North Carolina, Durham, NC; and the Departments of Emergency Medicine and Health Policy (J.M.P.), George Washington University, Washington, DC
| | - Nicole Lazarciuc
- From the State University of New York Downstate Medical Center/Kings County Hospital (P.C.), Brooklyn, NY; the Department of Neurology (B.L.C.), University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (N.L.), Hospital of the University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (F.S.S.), University of North Carolina, Durham, NC; and the Departments of Emergency Medicine and Health Policy (J.M.P.), George Washington University, Washington, DC
| | - Frances S. Shofer
- From the State University of New York Downstate Medical Center/Kings County Hospital (P.C.), Brooklyn, NY; the Department of Neurology (B.L.C.), University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (N.L.), Hospital of the University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (F.S.S.), University of North Carolina, Durham, NC; and the Departments of Emergency Medicine and Health Policy (J.M.P.), George Washington University, Washington, DC
| | - Jesse M. Pines
- From the State University of New York Downstate Medical Center/Kings County Hospital (P.C.), Brooklyn, NY; the Department of Neurology (B.L.C.), University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (N.L.), Hospital of the University of Pennsylvania, Philadelphia, PA; the Department of Emergency Medicine (F.S.S.), University of North Carolina, Durham, NC; and the Departments of Emergency Medicine and Health Policy (J.M.P.), George Washington University, Washington, DC
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