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Abreu P, Correia M, Azevedo E, Sousa-Pinto B, Magalhães R. Rapid systematic review of readmissions costs after stroke. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:22. [PMID: 38475856 DOI: 10.1186/s12962-024-00518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Stroke readmissions are considered a marker of health quality and may pose a burden to healthcare systems. However, information on the costs of post-stroke readmissions has not been systematically reviewed. OBJECTIVES To systematically review information about the costs of hospital readmissions of patients whose primary diagnosis in the index admission was a stroke. METHODS A rapid systematic review was performed on studies reporting post-stroke readmission costs in EMBASE, MEDLINE, and Web of Science up to June 2021. Relevant data were extracted and presented by readmission and stroke type. The original study's currency values were converted to 2021 US dollars based on the purchasing power parity for gross domestic product. The reporting quality of each of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. RESULTS Forty-four studies were identified. Considerable variability in readmission costs was observed among countries, readmissions, stroke types, and durations of the follow-up period. The UK and the USA were the countries reporting the highest readmission costs. In the first year of follow-up, stroke readmission costs accounted for 2.1-23.4%, of direct costs and 3.3-21% of total costs. Among the included studies, only one identified predictors of readmission costs. CONCLUSION Our review showed great variability in readmission costs, mainly due to differences in study design, countries and health services, follow-up duration, and reported readmission data. The results of this study can be used to inform policymakers and healthcare providers about the burden of stroke readmissions. Future studies should not solely focus on improving data standardization but should also prioritize the identification of stroke readmission cost predictors.
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Affiliation(s)
- Pedro Abreu
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Correia
- Department of Neurology, Hospital Santo António- Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Elsa Azevedo
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Bernardo Sousa-Pinto
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Magalhães
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Ferrone SR, Boltyenkov AT, Lodato Z, O'Hara J, Vialet J, Malhotra A, Katz JM, Wang JJ, Feizullayeva C, Sanelli PC. Clinical Outcomes and Costs of Recurrent Ischemic Stroke: A Systematic Review. J Stroke Cerebrovasc Dis 2022; 31:106438. [PMID: 35397253 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/04/2022] [Accepted: 02/23/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE Recurrent stroke patients suffer significant morbidity and mortality, representing almost 30% of the stroke population. Our objective was to determine the clinical outcomes and costs of recurrent ischemic stroke (recurrent-IS). METHODS Our study protocol was registered with the International Prospective Register of Systematic Reviews (CRD42020192709). Following PRISMA guidelines, our medical librarian conducted a search in EMBASE, PubMed, Web-of-Science, Scopus, and CINAHL (last performed on August 25, 2020). INCLUSION CRITERIA (1) Studies reporting clinical outcomes and/or costs of recurrent-IS; (2) Original research published in English in year 2010 or later; (3) Study participants aged ≥18 years. EXCLUSION CRITERIA (1) Case reports/studies, abstracts/posters, Editorial letters/reviews; (2) Studies analyzing interventions other than intravenous thrombolysis and thrombectomy. Four independent reviewers selected studies with review of titles/abstracts and full-text, and performed data extraction. Discrepancies were resolved by a senior independent arbitrator. Risk-of-bias was assessed using the Mixed Methods Appraisal Tool. RESULTS Initial search yielded 20,428 studies. Based on inclusion/exclusion criteria, 9 studies were selected, consisting of 24,499 recurrent-IS patients. In 5 studies, recurrent-IS ranged from 4.4-56.8% of the ischemic stroke cohorts at 3 or 12 months, or undefined follow-up. Mean age was 60-80 years and female proportions were 38.5-61.1%. Clinical outcomes included mortality 11.6-25.9% for in-hospital, 30-days, or 4-years (3 studies). In one study from the U.S., mean in-hospital costs were $17,121(SD-$53,693) and 1-year disability costs were $34,639(SD-$76,586) per patient. CONCLUSIONS Our study highlights the paucity of data on clinical outcomes and costs of recurrent-IS and identifies gaps in existing literature to direct future research.
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Affiliation(s)
- Sophia R Ferrone
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA
| | - Artem T Boltyenkov
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA; Siemens Medical Solutions USA Inc., 40 Liberty Blvd, Malvern, PA 19355, USA
| | - Zachary Lodato
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA
| | - Joseph O'Hara
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA
| | - Jaclyn Vialet
- Clinical Medical Library, Northwell Health, 300 Community Drive, Manhasset, NY 11030, USA
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
| | - Jeffrey M Katz
- Department of Neurology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Jason J Wang
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA; Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA
| | - Chinara Feizullayeva
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA
| | - Pina C Sanelli
- Imaging Clinical Effectiveness and Outcomes Research (iCEOR), Institute of Health System Science, Feinstein Institutes for Medical Research, 600 Community Drive, Manhasset, NY 11030, USA; Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY 11549, USA.
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Catalán JM, García-Pérez JV, Blanco A, Martínez D, Lledó LD, García-Aracil N. Differences in Physiological Reactions Due to a Competitive Rehabilitation Game Modality. SENSORS (BASEL, SWITZERLAND) 2021; 21:3681. [PMID: 34070583 PMCID: PMC8199149 DOI: 10.3390/s21113681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/19/2021] [Accepted: 05/24/2021] [Indexed: 12/04/2022]
Abstract
Interpersonal rehabilitation games, compared to single-player games, enhance motivation and intensity level. Usually, it is complicated to restrict the use of the system to pairs of impaired patients who have a similar skill level. Thus, such games must be dynamically adapted. Difficulty-adaptation algorithms are usually based only on performance parameters. In this way, the patient's condition cannot be considered when adapting the game. Introducing physiological reactions could help to improve decision-making. However, it is difficult to control how social interaction influences physiological reactions, making it difficult to interpret physiological responses. This article aimed to explore the changes in physiological responses due to the social interaction of a competitive game modality. This pilot study involved ten unimpaired participants (five pairs). We defined different therapy sessions: (i) a session without a competitor; (ii) two sessions with a virtual competitor with different difficulty levels; (iii) a competitive game. Results showed a difference in the physiological response in the competitive mode concerning single-player mode only due to the interpersonal game modality. In addition, feedback from participants suggested that it was necessary to keep a certain difficulty level to make the activity more challenging, and therefore be more engaging and rewarding.
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Affiliation(s)
- José M. Catalán
- Biomedical Neuroengineering Research Group of the Bioengineering Institute, Miguel Hernandez University, 03202 Elche, Spain; (J.V.G.-P.); (A.B.); (D.M.); (L.D.L.); (N.G.-A.)
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Puumalainen A, Elonheimo O, Brommels M. Costs structure of the inpatient ischemic stroke treatment using an exact costing method. Heliyon 2020; 6:e04264. [PMID: 32613126 PMCID: PMC7322047 DOI: 10.1016/j.heliyon.2020.e04264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 11/19/2019] [Accepted: 06/17/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Most stroke care expenses are inhospital costs. Given the previously reported inaccuracy of conventional costing, the purpose of this study was to provide an accurate analysis of inpatient costs of stroke care in an acute care hospital. Materials and methods We used activity-based costing (ABC) for calculating the costs of ischemic stroke patients. We collected the activity data at the Helsinki University Central Hospital. Persons involved in patient care logged their activities on survey forms for one week. The costs of activities were calculated based on information about salaries, material prices, and other costs obtained from hospital accounting data. We calculated costs per inpatient days and episodes, analyzed cost structure, made a distinction in cost for stroke subtypes according to the Oxford and TOAST classification schemes, and compared cost per inpatient episode with the diagnoses-related group (DRG) -price of the hospital. Results The sample comprised 196 inpatient days of 41 patients. By using the ABC, the mean and median costs of an inpatient day were 346 € and 268 €, and of an inpatient episode 3322 € and 2573 €, respectively. Average costs differed considerably by stroke subtype. The first inpatient day was the most expensive. Working time costs comprised 63% of the average inpatient day cost, with nursing constituting the largest proportion. The mean cost of an inpatient episode was 21% lower with ABC than with DRG pricing. Conclusion We demonstrate that there are differences in cost estimates depending on the methods used. ABC revealed differences among patients having the same diagnosis. The cost of an episode was lower than the DRG price of the hospital. Choosing an optimal costing method is essential for both reimbursements of hospitals and health policy decision-making.
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Affiliation(s)
- Anne Puumalainen
- Department of Public Health, University of Helsinki, Kajavankatu 2C 79, 04230, Kerava, Finland
- Corresponding author.
| | - Outi Elonheimo
- Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland
| | - Mats Brommels
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Wierzejska E, Giernaś B, Lipiak A, Karasiewicz M, Cofta M, Staszewski R. A global perspective on the costs of hypertension: a systematic review. Arch Med Sci 2020; 16:1078-1091. [PMID: 32863997 PMCID: PMC7444692 DOI: 10.5114/aoms.2020.92689] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/09/2019] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Hypertension, particularly untreated, leads to serious complications and contributes to high costs incurred by the whole society. The aim of the review was to carry out a social and economic comparison of various categories of hypertension costs from different countries. MATERIAL AND METHODS The study was a systematic review. PubMed, Cochrane Library and Google Scholar databases were searched. Hypertension costs were analyzed in 8 cost categories. An attempt was made to determine whether selected economic and social factors (such as HDI or GDP) influenced hypertension costs. RESULTS The review included data from 15 countries: Brazil, Cambodia, Canada, China, Greece, Indonesia, Italy, Jamaica, Kyrgyzstan, Mexico, Poland, Spain, USA, Vietnam and Zimbabwe. The papers included in the review were heterogeneous with respect to cost categories, which made comparisons difficult. The average total costs of hypertension for all the studied countries, calculated per person, amounted to 630.14 Int$, direct costs - 1,497.36 Int$, and indirect costs - 282.34 Int$. The ranking of countries by costs and by selected economic and social indices points at the possible relationship between these indices and hypertension costs. CONCLUSIONS The costs of hypertension calculated per country reached the region of several dozen billion Int$. Other sources usually showed lower costs than those presented in this review. This indicates a growth in costs from year to year and the future increasing burden on society. Globally uniform cost terminology and cost calculation standards need to be developed. That would facilitate making more informed decisions regarding fund allocation in hypertension management schemes.
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Affiliation(s)
- Ewelina Wierzejska
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Bogusz Giernaś
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Lipiak
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Karasiewicz
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Mateusz Cofta
- Department of Preventive Medicine, Laboratory of International Health, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafał Staszewski
- Department of Hypertensiology, Angiology and Internal Medicine, Laboratory of Pharmacoeconomics in Hypertension, Poznan University of Medical Sciences, Poznan, Poland
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Safanelli J, Vieira LGDR, Araujo TD, Manchope LFS, Kuhlhoff MHR, Nagel V, Conforto AB, Silva GS, Mazin S, Magalhães PSCD, Cabral NL. The cost of stroke in a public hospital in Brazil: a one-year prospective study. ARQUIVOS DE NEURO-PSIQUIATRIA 2019; 77:404-411. [PMID: 31314842 DOI: 10.1590/0004-282x20190059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/18/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Low- and middle-income countries face tight health care budgets, not only new resources, but also costly therapeutic resources for treatment of ischemic stroke (IS). However, few prospective data about stroke costs including cerebral reperfusion from low- and middle-income countries are available. To measure the costs of stroke care in a public hospital in Joinville, Brazil. METHODS We prospectively assessed all medical and nonmedical costs of inpatients admitted with a diagnosis of any stroke or transient ischemic attack over one year, analyzed costs per type of stroke and treatment, length of stay (LOS) and compared hospital costs with government reimbursement. RESULTS We evaluated 274 patients. The total cost for the year was US$1,307,114; the government reimbursed the hospital US$1,095,118. We found a significant linear correlation between LOS and costs (r = 0.71). The median cost of 134 IS inpatients who did not undergo cerebral reperfusion (National Institutes of Health Stroke Scale [NIHSS] median = 3 ) was US$2,803; for IS patients who underwent intravenous (IV) alteplase (NIHSS 10), the median was US$5,099, and for IS patients who underwent IV plus an intra-arterial (IA) thrombectomy (NIHSS > 10), the median cost was US$10,997. The median costs of a primary intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack were US$2,436, US$8,031 and US$2,677, respectively. CONCLUSIONS Reperfusion treatments were two-to-four times more expensive than conservative treatment. A cost-effectiveness study of the IS treatment option is necessary.
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Affiliation(s)
- Juliana Safanelli
- Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil
| | | | - Tainá de Araujo
- Universidade da Região de Joinville, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil
| | | | - Maria Helena Ribeiro Kuhlhoff
- Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil
| | - Vivian Nagel
- Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil
| | - Adriana Bastos Conforto
- Universidade Federal de São Paulo, Divisão de Clínica Neurológica, São Paulo, SP, Brasil.,Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Suleimy Mazin
- Universidade de São Paulo de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brasil
| | | | - Norberto Luiz Cabral
- Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil
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Abdo RR, Abboud HM, Salameh PG, Jomaa NA, Rizk RG, Hosseini HH. Direct Medical Cost of Hospitalization for Acute Stroke in Lebanon: A Prospective Incidence-Based Multicenter Cost-of-Illness Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 55:46958018792975. [PMID: 30111269 PMCID: PMC6432671 DOI: 10.1177/0046958018792975] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Stroke is a major social and health problem posing heavy burden on national economies. We provided detailed financial data on the direct in-hospital cost of acute stroke care in Lebanon and evaluated its drivers. This was an observational, quantitative, prospective, multicenter, incidence-based, bottom-up cost-of-illness study. Medical and billing records of stroke patients admitted to 8 hospitals in Beirut over 1 year were analyzed. Direct medical costs were calculated, and cost drivers were assessed using a multivariable linear regression analysis. In total, 203 stroke patients were included (male: 58%; mean age: 68.8 ± 12.9 years). The direct in-hospital cost for all cases was US$1 413 069 for 2626 days (US$538 per in-hospital day). The average in-hospital cost per stroke patient was US$6961 ± 15 663. Hemorrhagic strokes were the most costly, transient ischemic attack being the least costly. Cost drivers were hospital length of stay, intensive care unit length of stay, type of stroke, stroke severity, modified Rankin Scale, third party payer, surgery, and infectious complications. Direct medical cost of acute stroke care represents high financial burden to Lebanese health system. Development of targeted public health policies and primary prevention activities need to take priority to minimize stroke admission in future and to contain this cost.
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Affiliation(s)
- Rachel R Abdo
- 1 Lebanese University, Beirut, Lebanon.,2 Paris-Est University, Creteil, France.,3 Institut National de Santé Publique, d'Epidémiologie Clinique et Toxicologie - Liban, Fanar, Lebanon
| | | | - Pascale G Salameh
- 1 Lebanese University, Beirut, Lebanon.,3 Institut National de Santé Publique, d'Epidémiologie Clinique et Toxicologie - Liban, Fanar, Lebanon
| | - Najo A Jomaa
- 1 Lebanese University, Beirut, Lebanon.,5 Lebanese Geitaoui Hospital, Beirut, Lebanon
| | - Rana G Rizk
- 3 Institut National de Santé Publique, d'Epidémiologie Clinique et Toxicologie - Liban, Fanar, Lebanon.,6 Maastricht University, The Netherlands
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Rajsic S, Gothe H, Borba HH, Sroczynski G, Vujicic J, Toell T, Siebert U. Economic burden of stroke: a systematic review on post-stroke care. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:107-134. [PMID: 29909569 DOI: 10.1007/s10198-018-0984-0] [Citation(s) in RCA: 254] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 05/03/2018] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps. METHODS A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated. RESULTS We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors. CONCLUSION The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.
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Affiliation(s)
- S Rajsic
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - H Gothe
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Health Sciences/Public Health, Dresden Medical School "Carl Gustav Carus", Technical University Dresden, Dresden, Germany
| | - H H Borba
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
- Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil
| | - G Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria
| | - J Vujicic
- Faculty of Philosophy, University of Belgrade, Belgrade, Serbia
| | - T Toell
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria.
- Department of Health Policy and Management, Center for Health Decision Science, Harvard Chan School of Public Health, Boston, MA, USA.
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Manju MA, Candel MJJM, van Breukelen GJP. SamP2CeT: an interactive computer program for sample size and power calculation for two-level cost-effectiveness trials. Comput Stat 2018. [DOI: 10.1007/s00180-018-0829-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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10
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Zhao Y, Guthridge S, Falhammar H, Flavell H, Cadilhac DA. Cost-effectiveness of stroke care in Aboriginal and non-Aboriginal patients: an observational cohort study in the Northern Territory of Australia. BMJ Open 2017; 7:e015033. [PMID: 28982808 PMCID: PMC5640075 DOI: 10.1136/bmjopen-2016-015033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess cost-effectiveness of stroke care for Aboriginal compared with non-Aboriginal patients in the Northern Territory (NT), Australia. DESIGN Cost-effectiveness analysis using data from a cohort-based follow-up study of stroke incidents. SETTING Public hospitals in the NT from 1992 to 2013. PARTICIPANTS Individual patient data were extracted and linked from the hospital inpatient and primary care information systems. OUTCOME MEASURES Incremental cost-effectiveness ratios were calculated and assessed graphically. Survival time was used to measure effectiveness of stroke care, in comparison with the net costs per life-year gained, from a healthcare perspective, by applying multivariable models to account for time-dependent confounding. RESULTS 2158 patients with incident stroke were included (1171 males, 1178 aged <65 years and 966 from remote areas). 992 patients were of Aboriginal origin (46.0%, disproportionately higher than the population proportion of 27%). Of all cases, 42.6% were ischaemic and 29.8% haemorrhagic stroke. Average age of stroke onset was 51 years in Aboriginal, compared with 65 years in non-Aboriginal patients (p<0.001). Aboriginal patients had 71.4% more hospital bed-days, and 7.4% fewer procedures than non-Aboriginal patients. Observed health costs averaged $A50 400 per Aboriginal compared with $A33 700 per non-Aboriginal patient (p<0.001). The differential costs and effects for each population were distributed evenly across the incremental cost-effectiveness plane threshold line, indicating no difference in cost-effectiveness between populations. After further adjustment for confounding and censoring, cost-effectiveness appeared greater for Aboriginal than non-Aboriginal patients, but this was not statistically significant (p=0.25). CONCLUSIONS Stroke care for the NT Aboriginal population is at least as cost-effective as the non-Aboriginal population. Stroke care presents worthwhile and equitable survival benefits for Aboriginal patients in remote communities, notwithstanding their higher level burden of disease. These findings are relevant for healthcare planning and policy development regarding equal access to stroke care for Aboriginal patients.
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Affiliation(s)
- Yuejen Zhao
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Steven Guthridge
- Health Gains Planning, Northern Territory Department of Health, Darwin, Northern Territory, Australia
- Menzies School of Health Research, Darwin, Northern Territory, Australia
| | - Henrik Falhammar
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Howard Flavell
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Dominique A Cadilhac
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia
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Joo H, Wang G, George MG. A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischemic stroke. Stroke Vasc Neurol 2017; 2:73-83. [PMID: 28736623 PMCID: PMC5516524 DOI: 10.1136/svn-2016-000063] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 02/04/2017] [Accepted: 02/06/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. AIMS To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times. SUMMARY OF REVIEW A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the key words acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving, and incremental cost-effectiveness analysis. The review is limited to original research articles published during 1995-2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 2 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective. CONCLUSIONS The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.
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Affiliation(s)
- Heesoo Joo
- Division for Heart Disease and Stroke Prevention, CDC; IHRC Inc., Atlanta, Georgia, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, USA
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, CDC, Atlanta, Georgia, USA
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Myint PK, O. Bachmann M, Loke YK, D. Musgrave S, Price GM, Hale R, Metcalf AK, Turner DA, Day DJ, A. Warburton E, Potter JF. Important factors in predicting mortality outcome from stroke: findings from the Anglia Stroke Clinical Network Evaluation Study. Age Ageing 2017; 46:83-90. [PMID: 28181626 PMCID: PMC5377905 DOI: 10.1093/ageing/afw175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022] Open
Abstract
Background although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short- and medium-term mortality. Methods data from a prospective multicentre study (2009–12) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient-related factors and service characteristics on stroke mortality outcome at 7, 30 and 365 days post stroke, and time to death within 1 year. Results a total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease and admission hyperglycaemia predicted 1-year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11–28% (P < 0.0001) and in 1-year mortality of 8–12% (P < 0.001). Conclusions there appears to be consistent and robust evidence of direct clinical benefit on mortality up to 1 year after acute stroke of higher numbers of trained nursing staff over and above that of other recognised mortality risk factors.
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Affiliation(s)
- Phyo Kyaw Myint
- Epidemiology Group, Institute of Applied Health Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Scotland, UK
- Clinical Gerontology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
- Address correspondence to: P. K. Myint. Tel: (+44) (0) 1224 437841; Fax: (+44) (0) 1224 437911.
| | - Max O. Bachmann
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Yoon Kong Loke
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | - Gill M. Price
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Rachel Hale
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Anthony Kneale Metcalf
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - David A. Turner
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Elizabeth A. Warburton
- Addenbrooke's Hospital, Cambridge, UK
- Department of Clinical Neuroscience, University of Cambridge, Cambridge, UK
| | - John F. Potter
- Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Babu MA. Commentary: Surgical Management of the Elderly With Traumatic Cervical Spinal Cord Injury: A Cost-Utility Analysis. Neurosurgery 2016; 79:426-7. [PMID: 27409406 DOI: 10.1227/neu.0000000000001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Maya A Babu
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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Kritikou P, Spengos K, Zakopoulos N, Tountas Y, Yfantopoulos J, Vemmos K. Resource utilization and costs for treatment of stroke patients in an acute stroke unit in Greece. Clin Neurol Neurosurg 2016; 142:8-14. [DOI: 10.1016/j.clineuro.2015.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 11/27/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
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Matchar DB, Bilger M, Do YK, Eom K. International Comparison of Poststroke Resource Use: A Longitudinal Analysis in Europe. J Stroke Cerebrovasc Dis 2015; 24:2256-62. [PMID: 26277294 DOI: 10.1016/j.jstrokecerebrovasdis.2015.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 06/06/2015] [Accepted: 06/10/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Long-term costs often represent a large proportion of the total costs induced by stroke, but data on long-term poststroke resource use are sparse, especially regarding the trajectory of costs by severity. We used a multinational longitudinal survey to estimate patterns of poststroke resource use by degree of functional disability and to compare resource use between regions. METHODS The Survey of Health, Ageing and Retirement in Europe (SHARE) is a multinational database of adults 50 years and older, which includes demographic information about respondents, age when stroke first occurred, current activity of daily living (ADL) limitations, and health care resource use in the year before interview. We modeled resource use with a 2-part regression for number of hospital days, home nursing hours, and paid and unpaid home caregiving hours. RESULTS After accounting for time since stroke, number of strokes and comorbidities, age, gender, and European regions, we found that poststroke resource use was strongly associated with ADL limitations. The duration since the stroke event was significantly associated only with inpatient care, and informal help showed significant regional heterogeneity across all ADL limitation levels. CONCLUSIONS Poststroke physical deficits appear to be a strong driver of long-term resource utilization; treatments that decrease such deficits offer substantial potential for downline cost savings. Analyzing internationally comparable panel data, such as SHARE, provide valuable insight into long-term cost of stroke. More comprehensive international comparisons will require registries with follow-up, particularly for informal and formal home-based care.
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Affiliation(s)
- David B Matchar
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore; Department of Internal Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina.
| | - Marcel Bilger
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Young K Do
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea; Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea
| | - Kirsten Eom
- Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
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Ayis S, Wellwood I, Rudd AG, McKevitt C, Parkin D, Wolfe CDA. Variations in Health-Related Quality of Life (HRQoL) and survival 1 year after stroke: five European population-based registers. BMJ Open 2015; 5:e007101. [PMID: 26038354 PMCID: PMC4458636 DOI: 10.1136/bmjopen-2014-007101] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE There were two main objectives: to describe and compare clinical outcomes and Patient-Reported Outcome Measures (PROMs) collected using standardised procedures across the European Registers of Stroke (EROS) at 3 and 12 months after stroke; and to examine the relationship between patients' Health-Related Quality of Life (HRQoL) at 3 months after stroke and survival up to 1 year across the 5 populations. DESIGN Analysis of data from population-based stroke registers. SETTING European populations in Dijon (France); Kaunas (Lithuania); London (UK); Warsaw (Poland) and Sesto Fiorentino (Italy). PARTICIPANTS Patients with ischaemic or intracerebral haemorrhage (ICH) stroke, registered between 2004 and 2006. OUTCOME MEASURES (1) HRQoL, assessed by the physical component summary (PCS) and mental component summary (MCS) of the Short-Form Health Survey (SF-12), mapped into the EQ-5D to estimate responses on 5 dimensions (mobility, activity, pain, anxiety and depression, and self-care) and utility scores. (2) Mortality within 3 months and within 1 year of stroke. RESULTS Of 1848 patients, 325 were lost to follow-up and 500 died within a year of stroke. Significant differences in mortality, HRQoL and utility scores were found, and remained after adjustments. Kaunas had an increased risk of death; OR 2.34, 95% CI (1.32 to 4.14) at 3 months after stroke in Kaunas, compared with London. Sesto Fiorentino had the highest adjusted PCS: 43.54 (SD=0.96), and Dijon had the lowest adjusted MCS 38.67 (SD=0.67). There are strong associations between levels of the EQ-5D at 3 months and survival within the year. The trend across levels suggests a dose-response relationship. CONCLUSIONS The study demonstrated significant variations in survival, HRQoL and utilities across populations that could not be explained by stroke severity and sociodemographic factors. Strong associations between HRQoL at 3 months and survival to 1 year after stroke were identified.
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Affiliation(s)
- Salma Ayis
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - Ian Wellwood
- Division of Health and Social Care Research, King's College London, London, UK
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Anthony G Rudd
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - Christopher McKevitt
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - David Parkin
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
| | - Charles D A Wolfe
- Division of Health and Social Care Research, King's College London, London, UK
- NIHR Biomedical Research Centre at Guy's & St Thomas’ NHS Foundation Trust and King's College London, London, UK
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Joo H, George MG, Fang J, Wang G. A literature review of indirect costs associated with stroke. J Stroke Cerebrovasc Dis 2014; 23:1753-63. [PMID: 24957313 DOI: 10.1016/j.jstrokecerebrovasdis.2014.02.017] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/21/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of mortality and long-term disability. However, the indirect costs of stroke, such as productivity loss and costs of informal care, have not been well studied. To better understand this, we conducted a literature review of the indirect costs of stroke. METHODS A literature search using PubMed, MEDLINE, and EconLit, with the key words stroke, cerebrovascular disease, subarachnoid hemorrhage, intracerebral hemorrhage, cost-of-illness, productivity loss, indirect cost, economic burden, and informal caregiving was conducted. We identified original research articles published during 1990-2012 in English-language peer-reviewed journals. We summarized indirect costs by study type, cost categories, and study settings. RESULTS We found 31 original research articles that investigated the indirect cost of stroke. Six of these investigated indirect costs only; the other 25 studies were cost-of-illness studies that included indirect costs as a component. Of the 31 articles, 6 examined indirect costs in the United States, with 2 of these focused solely on indirect costs. Because of diverse methods, kinds of data, and definitions of cost used in the studies, the literature indicated a very wide range internationally in the proportion of the total cost of stroke that is represented by indirect costs (from 3% to 71%). CONCLUSIONS Most of the literature indicates that indirect costs account for a significant portion of the economic burden of stroke, and there is a pressing need to develop proper approaches to analyze these costs and to make better use of relevant data sources for such studies or establish new ones.
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Affiliation(s)
- Heesoo Joo
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
| | - Mary G George
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Jing Fang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia
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Wolfe CDA, Rudd AG, McKevitt C. Modelling, evaluating and implementing cost-effective services to reduce the impact of stroke. PROGRAMME GRANTS FOR APPLIED RESEARCH 2014. [DOI: 10.3310/pgfar02020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BackgroundStroke is a leading cause of death and disability but there is little information on the longer-term needs of patients and those of different ethnic groups.ObjectivesTo estimate risk of stroke, longer-term needs and outcomes, risk of recurrence, trends and predictors of effective care, to model cost-effective configurations of care, to understand stakeholders’ perspectives of services and to develop proposals to underpin policy.DesignPopulation-based stroke register, univariate and multivariate analyses, Markov and discrete event simulation, and qualitative methods for stakeholder perspectives of care and outcome.SettingSouth London, UK, with modelling for estimates of cost-effectiveness.ParticipantsInner-city population of 271,817 with first stroke in lifetime between 1995 and 2012.Outcome measuresStroke incidence rates and trends, recurrence, survival, activities of daily living, anxiety, depression, quality of life, appropriateness and cost-effectiveness of care, and qualitative narratives of perspectives.Data sourcesSouth London Stroke Register (SLSR), qualitative data, group discussions.ResultsStroke incidence has decreased since 1995, particularly in the white population, but with a higher stroke risk in black groups. There are variations in risk factors and types of stroke between ethnic groups and a large number of strokes occurred in people with untreated risk factors with no improvement in detection observed over time. A total of 30% of survivors have a poor range of outcomes up to 10 years after stroke with differences in outcomes by sociodemographic group. Depression affects over half of all stroke patients and the prevalence of cognitive impairment remains 22%. Survival has improved significantly, particularly in the older black groups, and the cumulative risk of recurrence at 10 years is 24.5%. The proportion of patients receiving effective acute stroke care has significantly improved, yet inequalities of provision remain. Using register data, the National Audit Office (NAO) compared the levels of stroke care in the UK in 2010 with previous provision levels and demonstrated that improvements have been cost-effective. The treatment of, and productivity loss arising from, stroke results in total societal costs of £8.9B a year and 5% of UK NHS costs. Stroke unit care followed by early supported discharge is a cost-effective strategy, with the main gain being years of life saved. Half of stroke survivors report unmet long-term needs. Needs change over time, but may not be stroke specific. Analysis of patient journeys suggests that provision of care is also influenced by structural, social and personal characteristics.Conclusions/recommendationsThe SLSR has been a platform for a range of health services research activities of international relevance. The programme has produced data to inform policy and practice with estimates of need for stroke prevention and care services, identification of persistent sociodemographic inequalities in risk and care despite a reduction in stroke risk, quantification of the effectiveness and cost-effectiveness of care and development of models to simulate configurations of care. Stroke is a long-term condition with significant social impact and the data on need and economic modelling have been utilised by the Department of Health, the NAO and Healthcare for London to assess need and model cost-effective options for stroke care. Novel approaches are now required to ensure that such information is used effectively to improve population and patient outcomes.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and the Department of Health via the National Institute for Health Research Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London.
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Affiliation(s)
- Charles DA Wolfe
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
| | - Anthony G Rudd
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Christopher McKevitt
- Department of Primary Care and Public Health Sciences, Division of Health and Social Care Research, School of Medicine, King’s College London, London, UK
- National Institute for Health Research Biomedical Research Centre, Guy’s and St Thomas’ NHS Foundation Trust and King’s College London, London, UK
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Quinn TJ, Dawson J. Acute ‘strokenomics’: efficacy and economic analyses of alteplase for acute ischemic stroke. Expert Rev Pharmacoecon Outcomes Res 2014; 9:513-22. [DOI: 10.1586/erp.09.63] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Karnon J, Caffrey O, Pham C, Grieve R, Ben-Tovim D, Hakendorf P, Crotty M. Applying risk adjusted cost-effectiveness (RAC-E) analysis to hospitals: estimating the costs and consequences of variation in clinical practice. HEALTH ECONOMICS 2013; 22:631-642. [PMID: 22544373 DOI: 10.1002/hec.2828] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Revised: 12/02/2011] [Accepted: 04/02/2012] [Indexed: 05/31/2023]
Abstract
Cost-effectiveness analysis is well established for pharmaceuticals and medical technologies but not for evaluating variations in clinical practice. This paper describes a novel methodology--risk adjusted cost-effectiveness (RAC-E)--that facilitates the comparative evaluation of applied clinical practice processes. In this application, risk adjustment is undertaken with a multivariate matching algorithm that balances the baseline characteristics of patients attending different settings (e.g., hospitals). Linked, routinely collected data are used to analyse patient-level costs and outcomes over a 2-year period, as well as to extrapolate costs and survival over patient lifetimes. The study reports the relative cost-effectiveness of alternative forms of clinical practice, including a full representation of the statistical uncertainty around the mean estimates. The methodology is illustrated by a case study that evaluates the relative cost-effectiveness of services for patients presenting with acute chest pain across the four main public hospitals in South Australia. The evaluation finds that services provided at two hospitals were dominated, and of the remaining services, the more effective hospital gained life years at a low mean additional cost and had an 80% probability of being the most cost-effective hospital at realistic cost-effectiveness thresholds. Potential determinants of the estimated variation in costs and effects were identified, although more detailed analyses to identify specific areas of variation in clinical practice are required to inform improvements at the less cost-effective institutions.
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Affiliation(s)
- Jonathan Karnon
- School of Population Health and Clinical Practice, University of Adelaide, Adelaide, Australia.
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Peltola M, Quentin W. Diagnosis-related groups for stroke in Europe: patient classification and hospital reimbursement in 11 countries. Cerebrovasc Dis 2013; 35:113-23. [PMID: 23406838 DOI: 10.1159/000346092] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 11/22/2012] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Diagnosis-related groups (DRGs) are increasingly being used for various purposes in many countries. However, there are no studies comparing different DRG systems in the care of stroke. As part of the EuroDRG project, researchers from 11 countries (i.e. Austria, England, Estonia, Finland, France, Germany, Ireland, the Netherlands, Poland, Sweden and Spain) compared how their DRG systems deal with stroke patients. The study aims to assist clinicians and national authorities to optimize their DRG systems. METHODS National or regional databases were used to identify hospital cases with a diagnosis of stroke. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that individually represent at least 1% of stroke cases. In addition, standardized case vignettes were defined, and quasi prices according to national DRG-based hospital payment systems were ascertained. RESULTS European DRG systems vary widely: they classify stroke patients according to different sets of variables (between 1 and 7 classification variables) into diverging numbers of DRGs (between 1 and 10 DRGs). In 6 of the countries more than half of the patients are concentrated within a single DRG. The countries' systems also vary with respect to the evaluation of different kinds of stroke patients. The most complex DRG is considered 3.8 times more resource intensive than an index case in Finland. By contrast, in England, the DRG system does not account for complex cases. Comparisons of quasi prices for the case vignettes show that hypothetical payments for the index case amount to only EUR 907 in Poland but to EUR 7,881 in Ireland. CONCLUSIONS Large variations in the classification of stroke patients raise concerns whether all systems rely on the most appropriate classification variables and whether the DRGs adequately reflect differences in the complexity of treating different groups of patients. Learning from other DRG systems may help in improving the national systems. Clinicians and national DRG authorities should consider how other countries' DRG systems classify stroke patients in order to optimize their DRG system and to ensure fair and appropriate reimbursement. In future, quantitative research is needed to verify whether the most important determinants of cost are considered in different patient classification systems, and whether differences between systems reflect country-specific differences in treatment patterns and, most importantly, what influence they have on patient outcomes.
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Affiliation(s)
- Mikko Peltola
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland.
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Fattore G, Torbica A, Susi A, Giovanni A, Benelli G, Gozzo M, Toso V. The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol 2012; 12:137. [PMID: 23150894 PMCID: PMC3536660 DOI: 10.1186/1471-2377-12-137] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 10/15/2012] [Indexed: 12/31/2022] Open
Abstract
Background The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission. Methods The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs) and productivity losses. The relation between costs of stroke management and socio-demographic and clinical characteristics as well as disability levels was evaluated in a series of bivariate analyses using non parametric tests (Mann Whitney and Kruskal-Wallis). Multiple linear regression analyses were performed to determine predictors of costs incurred by stroke patients during the acute phase and follow-up of 1 year. Results On average, one-year healthcare and societal costs amounted to €11,747 and € 19,953 per stroke survivor, respectively. The major cost component of societal costs was informal care accounting for € 6,656 (33.4% of total), followed by the initial hospitalisation, (€ 5,573; 27.9% of total), rehabilitation during follow up (€ 4,112; 20.6 %), readmissions (€ 439) and specialist and general practioner visits (€ 326). Mean drug costs per patient over the follow-up period was about € 50 per month. Costs associated to the provision of paid and informal care followed different pattern and were persistent over time (ranging from € 639 to € 597 per month in the first and the second part of the year, respectively). Clinical variables (presence of diabetes mellitus and hemorrhagic stroke) were significant predictors of total healthcare costs while functional outcomes (Barthel Index and Modified Ranking Scale scores) were significantly associated with both healthcare and societal costs at one year. Conclusions The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate “social” support.
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Affiliation(s)
- Giovanni Fattore
- Centre for Research on Health and Social Care Management (CERGAS) and SDA Bocconi, Università Bocconi, Milan, Italy.
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Zeng X, Karnon J, Wang S, Wu B, Wan X, Peng L. The cost of treating advanced non-small cell lung cancer: estimates from the chinese experience. PLoS One 2012; 7:e48323. [PMID: 23118985 PMCID: PMC3485140 DOI: 10.1371/journal.pone.0048323] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Because of the potentially significant economic burden of healthcare costs associated with many diseases, it is critical that regulatory and medical insurance organisations collect and utilise data on the cost-effectiveness of care provision to make rational policy decisions. However, little is known about healthcare costs in China. METHODOLOGY/PRINCIPAL FINDINGS Based on health expenditure data for 253 cases of advanced non-small cell lung cancer (NSCLC) registered at the Second Xiangya Hospital of Central South University in China between 2006 and 2010, the cost of care provision was analysed. The monthly and aggregate annual medical costs were estimated for patients who were in either a progression-free state (PFS) or a disease-progression state (DPS). Monthly healthcare costs accumulated during the terminal 3 months were collected separately. The mean cost of treatment for PFS and DPS patients over one year was approximately US$11,566 and $14,519, respectively. The monthly costs for all patients were higher initially than in the subsequent months (PFS: $2,490; DPS: $2,503). For PFS patients, healthcare expenditures stabilised after the 7th month, with a mean monthly medical expenditure of $82.49. For DPS patients, expenditures stabilised after the 9th month, and the mean expenditure during the 9th month was $307.9. Medical care costs in the three successive months prior to death were $3,754, $5,829 and $7,372, respectively. CONCLUSIONS/SIGNIFICANCE The economic evaluation of health care technologies is becoming ever more important in China, especially in disease areas for which new and expensive therapies are being introduced on a regular basis. This is first paper to present empirically estimated China-specific costs associated with the treatment of NSCLC. The cost estimates are presented in a format that is specifically intended to inform cost-effectiveness analyses of treatments for NSCLC, and hence, contribute to the more efficient allocation of limited healthcare resources in China.
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Affiliation(s)
- Xiaohui Zeng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
| | - Jonathan Karnon
- Department of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Siying Wang
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
| | - Bin Wu
- Department of Pharmacy, School of Medicine, Shanghai Jiaotong University, Renji Hospital, Shanghai, People’s Republic of China
| | - Xiaomin Wan
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
| | - Liubao Peng
- Department of Pharmacy, the Second Xiangya Hospital of Central South University, Changsha Hunan, People’s Republic of China
- School of Pharmaceutical Sciences, Central South University, Changsha Hunan, PR China
- * E-mail: .
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Sprigg N, Gray LJ, Bath PM, Christensen H, De Deyn PP, Leys D, O’Neill D, Ringelstein EB. Quality of Life after Ischemic Stroke Varies in Western Countries: Data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST). J Stroke Cerebrovasc Dis 2012; 21:587-93. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 01/20/2011] [Accepted: 01/22/2011] [Indexed: 10/18/2022] Open
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Evaluating the effects of variation in clinical practice: a risk adjusted cost-effectiveness (RAC-E) analysis of acute stroke services. BMC Health Serv Res 2012; 12:266. [PMID: 22905669 PMCID: PMC3526450 DOI: 10.1186/1472-6963-12-266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 07/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methods for the cost-effectiveness analysis of health technologies are now well established, but such methods may also have a useful role in the context of evaluating the effects of variation in applied clinical practice. This study illustrates a general methodology for the comparative analysis of applied clinical practice at alternative institutions--risk adjusted cost-effectiveness (RAC-E) analysis--with an application that compares acute hospital services for stroke patients admitted to the main public hospitals in South Australia. METHODS Using linked, routinely collected data on all South Australian hospital separations from July 2001 to June 2008, an analysis of the RAC-E of services provided at four metropolitan hospitals was undertaken using a decision analytic framework. Observed (plus extrapolated) and expected lifetime costs and survival were compared across patient populations, from which the relative cost-effectiveness of services provided at the different hospitals was estimated. RESULTS Unadjusted results showed that at one hospital patients incurred fewer costs and gained more life years than at the other hospitals (i.e. it was the dominant hospital). After risk adjustment, the cost minimizing hospital incurred the lowest costs, but with fewer life-years gained than one other hospital. The mean incremental cost per life-year gained of services provided at the most effective hospital was under $20,000, with an associated 65% probability of being cost-effective at a $50,000 per life year monetary threshold. CONCLUSIONS RAC-E analyses can be used to identify important variation in the costs and outcomes associated with clinical practice at alternative institutions. Such data provides an impetus for further investigation to identify specific areas of variation, which may then inform the dissemination of best practice service delivery and organisation.
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Peltola M. Patient classification and hospital costs of care for stroke in 10 European countries. HEALTH ECONOMICS 2012; 21 Suppl 2:129-140. [PMID: 22815118 DOI: 10.1002/hec.2841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Stroke is a major cause of death and disability around the world, and the care of stroke patients ties up a great amount of resources in healthcare systems. Stroke severity and the given care may vary substantially between patients, and there is remarkable variation in both the costs and length of stay (LoS) of stroke patients. Using patient level data from 10 European countries on costs and LoS, we explored the ability of the diagnosis-related group (DRG) systems to explain variance in the costs and length of stay of stroke patients. In addition, we evaluated whether the existing DRGs for stroke patients would benefit from additional patient-related and treatment-related factors that are commonly found in the administrative databases across countries. Cost analyses were run using OLS fixed effects models, and LoS analyses with negative binomial models. The descriptive statistics showed that the stroke patients differ remarkably across countries. Large variations in the classification of stroke patients raise concerns about whether all systems rely on the most appropriate classification variables. In all the countries, the DRG classifications' performance could be improved with the introduction of the patient characteristics analysed here.
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Affiliation(s)
- Mikko Peltola
- Centre for Health and Social Economics CHESS, National Institute for Health and Welfare, Helsinki, Finland.
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Affiliation(s)
- Charles D A Wolfe
- Division of Health and Social Care, King's College London, London SE1 3QD, UK.
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Bayer S, Petsoulas C, Cox B, Honeyman A, Barlow J. Facilitating stroke care planning through simulation modelling. Health Informatics J 2011; 16:129-43. [PMID: 20573645 DOI: 10.1177/1460458209361142] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Stroke is a leading cause of death and long-term severe disability. A major difficulty facing stroke care provision in the UK is the lack of service integration between the many authorities, professionals and stakeholders involved in the process. The objective of this article is to describe a prototype model to support integrative planning for local stroke care services.The model maps the flow of care in the acute and community segments of the care pathway for stroke patients and allows exploring alternatives for care provision. Simulation modelling can help to develop an understanding of the systemic impact of service change and improve the design and targeting of future services.
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Affiliation(s)
- Steffen Bayer
- Imperial College Business School, London SW72AZ, UK.
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29
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Myint PK, Potter JF, Price GM, Barton GR, Metcalf AK, Hale R, Dalton G, Musgrave SD, George A, Shekhar R, Owusu-Agyei P, Walsh K, Ngeh J, Nicholson A, Day DJ, Warburton EA, Bachmann MO. Evaluation of stroke services in Anglia Stroke Clinical Network to examine the variation in acute services and stroke outcomes. BMC Health Serv Res 2011; 11:50. [PMID: 21356059 PMCID: PMC3055813 DOI: 10.1186/1472-6963-11-50] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 02/28/2011] [Indexed: 11/08/2022] Open
Abstract
Background Stroke is the third leading cause of death in developed countries and the leading cause of long-term disability worldwide. A series of national stroke audits in the UK highlighted the differences in stroke care between hospitals. The study aims to describe variation in outcomes following stroke and to identify the characteristics of services that are associated with better outcomes, after accounting for case mix differences and individual prognostic factors. Methods/Design We will conduct a cohort study in eight acute NHS trusts within East of England, with at least one year of follow-up after stroke. The study population will be a systematically selected representative sample of patients admitted with stroke during the study period, recruited within each hospital. We will collect individual patient data on prognostic characteristics, health care received, outcomes and costs of care and we will also record relevant characteristics of each provider organisation. The determinants of one year outcome including patient reported outcome will be assessed statistically with proportional hazards regression models. Self (or proxy) completed EuroQol (EQ-5D) questionnaires will measure quality of life at baseline and follow-up for cost utility analyses. Discussion This study will provide observational data about health service factors associated with variations in patient outcomes and health care costs following hospital admission for acute stroke. This will form the basis for future RCTs by identifying promising health service interventions, assessing the feasibility of recruiting and following up trial patients, and provide evidence about frequency and variances in outcomes, and intra-cluster correlation of outcomes, for sample size calculations. The results will inform clinicians, public, service providers, commissioners and policy makers to drive further improvement in health services which will bring direct benefit to the patients.
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Affiliation(s)
- Phyo K Myint
- Norwich Medical School, Faculty of Medicine & Health Sciences, Norwich, UK.
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Addo J, Bhalla A, Crichton S, Rudd AG, McKevitt C, Wolfe CDA. Provision of acute stroke care and associated factors in a multiethnic population: prospective study with the South London Stroke Register. BMJ 2011; 342:d744. [PMID: 21349892 PMCID: PMC3044771 DOI: 10.1136/bmj.d744] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/09/2010] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To investigate time trends in receipt of effective acute stroke care and to determine the factors associated with provision of care. DESIGN Population based stroke register. SETTING South London. PARTICIPANTS 3800 patients with first ever ischaemic stroke or primary intracerebral haemorrhage registered between January 1995 and December 2009. MAIN OUTCOME MEASURES Acute care interventions, admission to hospital, care on a stroke unit, acute drugs, and inequalities in access to care. RESULTS Between 2007 and 2009, 5% (33/620) of patients were still not admitted to a hospital after an acute stroke, particularly those with milder strokes, and 21% (124/584) of patients admitted to hospital were not admitted to a stroke unit. Rates of admission to stroke units and brain imaging, between 1995 and 2009, and for thrombolysis, between 2005 and 2009, increased significantly (P<0.001). Black patients compared with white patients had a significantly increased odds of admission to a stroke unit (odds ratio 1.76, 95% confidence interval 1.35 to 2.29, P<0.001) and of receipt of occupational therapy or physiotherapy (1.90, 1.21 to 2.97, P=0.01), independent of age or stroke severity. Patients with motor or swallowing deficits were also more likely to be admitted to a stroke unit (1.52, 1.12 to 2.06, P=0.001 and 1.32, 1.02 to 1.72, P<0.001, respectively). Length of stay in hospital decreased significantly between 1995 and 2009 (P<0.001). The odds of brain imaging were lowest in patients aged 75 or more years (P=0.004) and those of lower socioeconomic status (P<0.001). The likelihood of those with a functional deficit receiving rehabilitation increased significantly over time (P<0.001). Patients aged 75 or more were more likely to receive occupational therapy or physiotherapy (P=0.002). CONCLUSION Although the receipt of effective acute stroke care improved between 1995 and 2009, inequalities in its provision were significant, and implementation of evidence based care was not optimal.
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Affiliation(s)
- Juliet Addo
- King's College London, Division of Health and Social Care Research, London, UK.
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Asil T, Celik Y, Sut N, Celik AD, Balci K, Yilmaz A, Karaduman F. Cost of acute ischemic and hemorrhagic stroke in Turkey. Clin Neurol Neurosurg 2010; 113:111-4. [PMID: 21036465 DOI: 10.1016/j.clineuro.2010.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2009] [Revised: 08/09/2010] [Accepted: 09/13/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study is to examine the direct medical costs and outcomes of patients with stroke. MATERIAL AND METHODS The records of the patients admitted with ischemic and hemorrhagic stroke to the University of Trakya, School of Medicine, Department of Neurology were reviewed retrospectively in year 2007. Direct medical costs (total costs, radiological, laboratory, medicine, and other) were calculated, additionally cost per life saved and per life-year saved were calculated for stroke patients. RESULTS The study group consisted of 328 patients (169 male/159 female) and mean age was 66.5 ± 12.4 years. Length of hospital stay was 10.7 ± 7.5 days. Mortality rate was 20.4% and the mRS score of the patients was 3.2 ± 2.1. The average cost of stroke was US$ 1677 ± 2964 (29.9% medicine, 19.9% laboratory, 12.8% neuroimaging, and 38% beds and staff). Cost per life saved and per life-year saved were US$ 2108 and US$ 1070, respectively. CONCLUSION This is the first study in order to determine direct medical cost of stroke in Turkey, therefore, it may be guideline for disease-cost management of stroke.
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Affiliation(s)
- Talip Asil
- Department of Neurology, University of Trakya, Edirne, Turkey
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Lin CL, Lin PH, Chou LW, Lan SJ, Meng NH, Lo SF, Wu HDI. Model-based prediction of length of stay for rehabilitating stroke patients. J Formos Med Assoc 2009; 108:653-62. [PMID: 19666353 DOI: 10.1016/s0929-6646(09)60386-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND/PURPOSE Accurate length-of-stay (LOS) estimates have an impact on medical costs for stroke patients. Most studies have reported only descriptive sample means or have provided linear-model-based estimates for LOS. This study calculated point and interval estimates by treating hospital discharge as an event, and utilizing the proportional hazards (PH) model to provide the estimation of hospital stay for first-ever stroke patients in a rehabilitation department of a clinical center. METHODS Pairwise analysis for correlations between age, sex, comorbidity status, modified Barthel index (MBI) and functional independence measure (FIM) was performed. These explanatory variables are used in the K-sample comparisons, the Chi-squared test for association, the PH regression analysis, and log-transformed linear (LTL) regression. RESULTS The PH model gave a prediction on estimated mean LOS, with an absolute bias of 0.85 days, by combining MBI and FIM into a single variable, or a bias of 1.15 days and 1.16 days with MBI and FIM variables, respectively. The LTL-based estimation generated a bias of 5.91 days. The PH model has relatively shorter confidence intervals than those obtained by sample-mean and LTL methods. CONCLUSION We recommend using the PH model for predicting mean LOS when the PH assumption for patients with different clinical characteristics is satisfied. However, the proposed method only applies to rehabilitating stroke patients.
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Affiliation(s)
- Chien-Lin Lin
- Department of Rehabilitation, China Medical University Hospital, Taiwan
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Facilities available in French hospitals treating acute stroke patients: comparison with 24 other European countries. J Neurol 2009; 256:867-73. [DOI: 10.1007/s00415-009-5029-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 11/02/2008] [Accepted: 11/19/2008] [Indexed: 11/26/2022]
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Stroke in the young: access to care and outcome; a Western versus eastern European perspective. J Stroke Cerebrovasc Dis 2009; 17:360-5. [PMID: 18984427 DOI: 10.1016/j.jstrokecerebrovasdis.2008.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/01/2008] [Accepted: 04/21/2008] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To develop effective strategies to address the needs of young patients with stroke, it is important to recognize what components of stroke care they receive. The aims of this study were to describe the provision of stroke care and the factors associated with 3-month mortality and disability (Barthel Index 0-14) in patients younger than 55 years across Western and Eastern Europe. METHODS Data from hospital-based stroke registers in Western Europe (7 centers, 6 countries) and Eastern Europe (4 centers, 3 countries) were analyzed. RESULTS Of 1735 patients admitted to hospital, 201 (11.5%) patients were younger than 55 years (Western European centers 51%, and Eastern European centers 49%). Stroke department care was higher in Western centers (67%) than in Eastern centers (24%) (P < .001). Doctor (P < .001), therapy (P = .01), and nursing (P < .001) time were higher in Western centers. At 3 months, case fatalities between Western and Eastern centers were 8% versus 23% (P = .003). Patients in Eastern European centers were more likely to have disability at 3 months (odds ratio = 24.3, confidence interval = 1.2-494, P = .04). CONCLUSION Young patients with stroke in Western Europe are more likely to gain access to a number of components of stroke care compared with those in Eastern Europe. The future challenge is to ensure that recommendations are adopted to ensure all young patients receive evidence-based stroke care across Europe.
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Lyrer PA. Acute stroke units and teams. HANDBOOK OF CLINICAL NEUROLOGY 2009; 94:1195-1203. [PMID: 18793895 DOI: 10.1016/s0072-9752(08)94058-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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36
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Gioldasis G, Talelli P, Chroni E, Daouli J, Papapetropoulos T, Ellul J. In-hospital direct cost of acute ischemic and hemorrhagic stroke in Greece. Acta Neurol Scand 2008; 118:268-74. [PMID: 18384454 DOI: 10.1111/j.1600-0404.2008.01014.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The geographic inequity and the wide variation in the patterns of care of stroke found across Europe together with the lack of health economics evaluation in Greece led to this prospective study, aiming to provide data on in-hospital direct cost of patients with an acute stroke in Greece, and to identify independent prognostic factors. METHODS Demographic and clinical data were recorded on 429 consecutive patients with an acute ischemic or hemorrhagic stroke admitted to a tertiary care hospital in Greece during a period of 18 months. The costs incurred were estimated using the official financial charts listing in euro (euro), the real expenditure of all hospital departments. RESULTS The direct in-hospital cost for all stroke cases was 1,551,445euro for a total of 4674 days (331.9euro per day in-hospital). The mean in-hospital cost per stroke patient was 3624.9euro (+/-2695.4). Hemorrhagic strokes were significantly more expensive than the ischemic strokes [mean 5305.4 (+/-4204.8)euro and 3214.5 (+/-1976.2)euro, respectively) and lacunar strokes the least expensive among ischemic stroke subtypes. The length of stay was highly correlated with in-hospital total cost. Multivariate linear regression analysis showed that admission ward, stroke severity on admission, stroke type and status discharge were independent predictors of cost. CONCLUSIONS Purchasers in our health services should differentiate in their cost estimates and pricing schemes between types of cerebrovascular events. Future studies should focus on modifiable factors related, not only with stroke characteristics, but also with operational policies of hospitals, that may influence length of stay.
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Affiliation(s)
- G Gioldasis
- Department of Neurology, University of Patras, Greece
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37
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Angquist L, Hössjer O, Groop L. Strategies for conditional two-locus nonparametric linkage analysis. Hum Hered 2008; 66:138-56. [PMID: 18418001 DOI: 10.1159/000126049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Accepted: 09/06/2007] [Indexed: 01/17/2023] Open
Abstract
In this article we deal with two-locus nonparametric linkage (NPL) analysis, mainly in the context of conditional analysis. This means that one incorporates single-locus analysis information through conditioning when performing a two-locus analysis. Here we describe different strategies for using this approach. Cox et al. [Nat Genet 1999;21:213-215] implemented this as follows: (i) Calculate the one-locus NPL process over the included genome region(s). (ii) Weight the individual pedigree NPL scores using a weighting function depending on the NPL scores for the corresponding pedigrees at speci fi c conditioning loci. We generalize this by conditioning with respect to the inheritance vector rather than the NPL score and by separating between the case of known (prede fi ned) and unknown (estimated) conditioning loci. In the latter case we choose conditioning locus, or loci, according to prede fi ned criteria. The most general approach results in a random number of selected loci, depending on the results from the previous one-locus analysis. Major topics in this article include discussions on optimal score functions with respect to the noncentrality parameter (NCP), and how to calculate adequate p values and perform power calculations. We also discuss issues related to multiple tests which arise from the two-step procedure with several conditioning loci as well as from the genome-wide tests.
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Affiliation(s)
- Lars Angquist
- Centre for Mathematical Sciences, Department of Mathematical Statistics, Lund University, Lund, Sweden.
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38
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Lindsell CJ, Alwell K, Moomaw CJ, Kleindorfer DO, Woo D, Flaherty ML, Air EL, Schneider AT, Ewing I, Broderick JP, Tsevat J, Kissela BM. Validity of a retrospective National Institutes of Health Stroke Scale scoring methodology in patients with severe stroke. J Stroke Cerebrovasc Dis 2008; 14:281-3. [PMID: 17904038 DOI: 10.1016/j.jstrokecerebrovasdis.2005.08.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Accepted: 08/05/2005] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Quantifying stroke severity is essential for interpreting outcomes in stroke studies; severity impacts outcomes. Because outcome studies often enroll patients some time after stroke and there is little standardization of the history and physical examination, objective measurement of stroke severity is limited. A method for retrospectively scoring the National Institutes of Health Stroke Scale (NIHSS) based on history and physical examination has been proposed, but has yet to be validated in patients with higher NIHSS score. We evaluate the validity of this scoring method across the spectrum of the NIHSS scores. METHODS The retrospective scoring algorithm was applied to history and physical examinations documented for 58 patients with ischemic stroke presenting to any of 17 regional acute care facilities who had a NIHSS score recorded by a stroke team physician. The retrospective NIHSS score was obtained by standardized chart review. Linear regression was used to estimate scale-dependent and scale-independent bias. Limits of agreement quantify deviation of the retrospective NIHSS score from the prospective NIHSS score. RESULTS Mean (SD) age at stroke was 66 (14) years; 27 (46.6%) patients were men, and 38 (65.5%) were white. The mean (SD) prospective NIHSS score was 13.6 (7.8); the mean (SD) retrospective NIHSS score was 13.7 (7.8). There were 23 (40%) prospective NIHSS scores above 15, and 13 scores (22%) above 20. The linear regression constant was 0.290 (95% confidence interval -0.107, 0.687); the slope was 0.987 (95% confidence interval 0.962, 1.013). The R(2) for the model was 0.991. Limits of agreement were -1.35 and 1.59. CONCLUSION The retrospective NIHSS appears valid across the entire spectrum of scores.
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Affiliation(s)
- Christopher J Lindsell
- Institute for the Study of Health, University of Cincinnati Medical Center, Cincinnati Ohio, USA
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Les apports du registre dijonnais des accidents vasculaires cérébraux en 20 ans d’activité. Rev Neurol (Paris) 2008; 164:138-47. [DOI: 10.1016/j.neurol.2007.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 05/10/2007] [Accepted: 06/17/2007] [Indexed: 11/18/2022]
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40
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Epstein D, Mason A, Manca A. The hospital costs of care for stroke in nine European countries. HEALTH ECONOMICS 2008; 17:S21-S31. [PMID: 18186037 DOI: 10.1002/hec.1329] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Stroke is a major cause of mortality and morbidity, but the reasons for differences in costs of care within and between countries are not well understood. The HealthBASKET project used a vignette methodology to compare the mean costs and prices of hospital care across providers in nine European Union countries. Data on resource use, unit costs and prices of care for female stroke patients without co-morbidity were collected from a sample of 50 hospitals. Mean costs for each provider were analysed using multiple regression. Sensitivity analysis explored the effects on cost of using official exchange rates, purchasing power parity (PPP) and proportion of national income per capita. The mean cost of a hospital episode per patient for stroke at PPP was 3813 euros (standard error 227) with an additional day in hospital typically associated with 6.9% (95% CI: 4-9%) higher costs and thrombolysis associated with 41% higher costs (10-73%). After adjusting for explanatory factors, about 76% of the variation in cost could be attributed to between-country differences, and the extent of this variation was sensitive to the method of currency conversion. There was considerable variation in the care pathways within and between countries, including differences in the availability of stroke units and access to rehabilitative services, but only the length of stay and use of thrombolytic therapy were significantly associated with higher cost. The vignette methodology appears feasible, but further research needs to consider access to healthcare over a longer follow up and to include both costs and outcomes.
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Affiliation(s)
- David Epstein
- Centre for Health Economics, University of York, UK.
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41
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Abstract
UK needs to reorganise services to follow the example of other countries
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42
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Grieve R, Nixon R, Thompson SG, Cairns J. Multilevel models for estimating incremental net benefits in multinational studies. HEALTH ECONOMICS 2007; 16:815-26. [PMID: 17191271 DOI: 10.1002/hec.1198] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Multilevel models (MLMs) have been recommended for estimating incremental net benefits (INBs) in multicentre cost-effectiveness analysis (CEA). However, these models have assumed that the INBs are exchangeable and that there is a common variance across all centres. This paper examines the plausibility of these assumptions by comparing various MLMs for estimating the mean INB in a multinational CEA. The results showed that the MLMs that assumed the INBs were exchangeable and had a common variance led to incorrect inferences. The MLMs that included covariates to allow for systematic differences across the centres, and estimated different variances in each centre, made more plausible assumptions, fitted the data better and led to more appropriate inferences. We conclude that the validity of assumptions underlying MLMs used in CEA need to be critically evaluated before reliable conclusions can be drawn.
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Affiliation(s)
- Richard Grieve
- Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
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Carinci F, Roti L, Francesconi P, Gini R, Tediosi F, Di Iorio T, Bartolacci S, Buiatti E. The impact of different rehabilitation strategies after major events in the elderly: the case of stroke and hip fracture in the Tuscany region. BMC Health Serv Res 2007; 7:95. [PMID: 17597513 PMCID: PMC1939994 DOI: 10.1186/1472-6963-7-95] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 06/27/2007] [Indexed: 11/14/2022] Open
Abstract
Background On a regional level, our aims were to describe rehabilitation patterns for elderly patients with stroke and hip fracture and to investigate mortality risk during the 6-month post acute period. Methods Data sources included administrative data relative to patients aged 65+ resident in Tuscany admitted in hospital for stroke or hip fracture between 2001 and 2003, traced up to 3 years before and 6 months following index admission. The study design involves computerized linkage of administrative data, and an exploratory analysis of the association between rehabilitation patterns and 6-month mortality, adjusting for clinical, demographic, and acute-related care characteristics using multivariate Cox regression. Results Rehabilitation patterns vary greatly across Tuscany with considerable cost implications. Six month mortality risk for stroke patients is significantly lower among residents of Local Health Authorities where patients are more frequently rehabilitated, specifically in extra-hospital settings. Conclusion Our study, targeting two crucial conditions for elderly patients, found a high variability of rehabilitation patterns across a region, albeit coherent between the two pathologies, associated with remarkable differences in average expenditure. Differences in hazard rates for 6-month mortality after stroke at population level were also found. These results need to be confirmed and further investigated through a more robust information framework.
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Affiliation(s)
| | - Lorenzo Roti
- Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | | | - Rosa Gini
- Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | | | | | | | - Eva Buiatti
- Agenzia Regionale di Sanità della Toscana, Firenze, Italy
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Lee H, Yoon SJ, Ahn HS, Moon OR. Estimation of potential health gains from reducing multiple risk factors of stroke in Korea. Public Health 2007; 121:774-80. [PMID: 17568640 DOI: 10.1016/j.puhe.2007.03.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2005] [Revised: 03/29/2006] [Accepted: 03/09/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To estimate the burden of diseases caused by stroke using disability-adjusted life years (DALY), and to compare the attributable burdens of risk factors with the avoidable burdens. METHODS First, we estimated the disease burden of stroke due to premature death and disability using 2001 morbidity and mortality data in Korea. Second, we selected risk factors and exposure variables of stroke, and decided, via systematic review, on the prevalence and relative risks of these risk factors. Third, we calculated the attributable burdens of stroke in relation to the current prevalence of risk factors, and calculated the avoidable burden of stroke in relation to the counterfactual prevalence of risk factors. RESULTS The burden of stroke per 100000 people was determined to be 3394.9 person-years for males, and 2532.2 person-years for females. The burden of stroke at its current prevalence for males per 100000 people was attributed primarily to smoking (1940.4 person-years), alcohol (864.3 person-years), and hypertension (667.3 person-years). The burden of stroke at its current prevalence for females per 100000 people was attributed primarily to alcohol (462.8 person-years), physical inactivity (455.7 person-years), and smoking (407.7 person-years). The joint population attributable fraction (PAF) to risk factors was determined to be 80.2% for males, and 52.4% for females. CONCLUSIONS The modification of risk factors constitutes a crucial component of any serious effort to reduce the burden of stroke. In order to reduce the burden of stroke, a health policy in regard to risk factors is clearly required.
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Affiliation(s)
- H Lee
- Division of Cancer Control and Epidemiology, National Cancer Center, Goyang City, Gyeonggi Province, South Korea
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Heidrich J, Heuschmann PU, Kolominsky-Rabas P, Rudd AG, Wolfe CDA. Variations in the use of diagnostic procedures after acute stroke in Europe: results from the BIOMED II study of stroke care. Eur J Neurol 2007; 14:255-61. [PMID: 17355544 DOI: 10.1111/j.1468-1331.2006.01573.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Valid classification of stroke is essential to initiate effective acute management and early secondary prevention strategies. To accurately evaluate stroke subtype a number of diagnostic procedures have to be performed. This study sought to investigate variations in use of diagnostic procedures across selected European hospitals. First-ever stroke patients were sampled over a 1-year period through 11 hospital-based registers across 10 European countries. We defined a diagnostic standard for valid aetiological classification of ischemic stroke including brain imaging, vascular imaging and echocardiography. The impact of socio-demographic, clinical and structural characteristics on performance of the diagnostic standard was assessed using multivariate logistic regression analyses. A total of 1721 patients were included in the study. 83.1% received brain imaging, ranging from 32.8% to 100%. The diagnostic standard was performed in 40.4% of stroke patients, ranging from 0% to 77.2%. Patients with increasing age (P < 0.001) and with more severe strokes (P = 0.001) were less probably to receive the diagnostic standard. Patients treated in stroke units and neurological departments were more frequently investigated with the diagnostic standard (P < 0.001). Less than half of hospitalized stroke patients across Europe underwent diagnostic procedures to allow for aetiological classification of stroke, which may hamper the initiation of effective early management and secondary prevention.
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Affiliation(s)
- J Heidrich
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
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Smith LN. Setting the agenda for neurological nursing: strategic directions. Int J Nurs Stud 2006; 43:1063-72. [PMID: 16386254 DOI: 10.1016/j.ijnurstu.2005.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 11/09/2005] [Accepted: 11/13/2005] [Indexed: 11/26/2022]
Abstract
This paper explores a range of issues related to neurological care. The scope and scale of neurological conditions is described in order to illustrate disparities in research funding and care delivery as compared with cancer and cardiovascular disease. Financial implications, ethical issues and health service development are outlined as a context for the state of the art of neurological nursing. Areas for potential neurological nursing research are identified. Finally, it is argued that policy and research must be linked if neurological care, research and education are to receive greater resource allocation.
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Thompson SG, Nixon RM, Grieve R. Addressing the issues that arise in analysing multicentre cost data, with application to a multinational study. JOURNAL OF HEALTH ECONOMICS 2006; 25:1015-28. [PMID: 16540192 DOI: 10.1016/j.jhealeco.2006.02.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Revised: 02/02/2006] [Accepted: 02/06/2006] [Indexed: 05/07/2023]
Abstract
Differences in the mean, spread and skewness of cost data collected from different countries present problems for analysis and interpretation. Here we develop generalised linear multilevel models to estimate the effects of patient and national characteristics on costs. Using gamma distributions and multiplicative effects for patient characteristics fitted the data better than models which assumed normal distributions or estimated additive effects. A multilevel gamma model is employed to allow for heterogeneity in the effects of patient case-mix across centres. Analysis of multinational cost data must recognise differences in mean, spread and skewness across centres, as well as the data's hierarchical structure.
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Affiliation(s)
- Simon G Thompson
- MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK.
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Boix R, del Barrio JL, Saz P, Reñé R, Manubens JM, Lobo A, Gascón J, de Arce A, Díaz-Guzmán J, Bergareche A, Bermejo-Pareja F, de Pedro-Cuesta J. Stroke prevalence among the Spanish elderly: an analysis based on screening surveys. BMC Neurol 2006; 6:36. [PMID: 17042941 PMCID: PMC1626484 DOI: 10.1186/1471-2377-6-36] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2006] [Accepted: 10/16/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study sought to describe stroke prevalence in Spanish elderly populations and compare it against that of other European countries. METHODS We identified screening surveys--both published and unpublished--in Spanish populations, which fulfilled specific quality requirements and targeted prevalence of stroke in populations aged 70 years and over. Surveys covering seven geographically different populations with prevalence years in the period 1991-2002 were selected, and the respective authors were then asked to provide descriptions of the methodology and raw age-specific data by completing a questionnaire. In addition, five reported screening surveys in European populations furnished useful data for comparison purposes. Prevalence data were combined, using direct adjustment and logistic regression. RESULTS The overall study population, resident in central and north-eastern Spain, totalled 10,647 persons and yielded 715 cases. Age-adjusted prevalences, using the European standard population, were 7.3% for men, 5.6% for women, and 6.4% for both sexes. Prevalence was significantly lower in women, OR 0.79 95% CI 0.68-0.93, increased with age, particularly among women, and displayed a threefold spatial variation with statistically significant differences. Prevalences were highest, 8.7%, in suburban, and lowest, 3.8%, in rural populations. Compared to pooled Spanish populations, statistically significant differences were seen in eight Italian populations, OR 1.39 95% CI (1.18-1.64), and in Kungsholmen, Sweden, OR 0.40 95% CI (0.27-0.58). CONCLUSION Prevalence in central and north-eastern Spain is higher in males and in suburban areas, and displays a threefold geographic variation, with women constituting the majority of elderly stroke sufferers. Compared to reported European data, stroke prevalence in Spain can be said to be medium and presents similar age- and sex-specific traits.
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Affiliation(s)
- Raquel Boix
- National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain
| | - José Luis del Barrio
- National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain
| | - Pedro Saz
- Department of Medicine and Psychiatry, Zaragoza University, Zaragoza, Spain
| | - Ramón Reñé
- Dementia Diagnosis and Treatment Unit, Neurology Department, Bellvitge University Teaching Hospital, Barcelona, Spain
| | | | - Antonio Lobo
- Department of Medicine and Psychiatry, Zaragoza University, Zaragoza, Spain
| | - Jordi Gascón
- Dementia Diagnosis and Treatment Unit, Neurology Department, Bellvitge University Teaching Hospital, Barcelona, Spain
| | - Ana de Arce
- Neurology Department, Donostia Hospital, Guipúzcoa, Spain
| | - Jaime Díaz-Guzmán
- Neurology Department, 12 de Octubre University Teaching Hospital, Madrid, Spain
| | | | | | - Jesús de Pedro-Cuesta
- National Centre for Epidemiology, Carlos III Institute of Public Health, Madrid, Spain
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Truelsen T, Piechowski-Jóźwiak B, Bonita R, Mathers C, Bogousslavsky J, Boysen G. Stroke incidence and prevalence in Europe: a review of available data. Eur J Neurol 2006; 13:581-98. [PMID: 16796582 DOI: 10.1111/j.1468-1331.2006.01138.x] [Citation(s) in RCA: 366] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Reliable data on stroke incidence and prevalence are essential for calculating the burden of stroke and the planning of prevention and treatment of stroke patients. In the current study we have reviewed the published data from EU countries, Iceland, Norway, and Switzerland, and provide WHO estimates for stroke incidence and prevalence in these countries. Studies on stroke epidemiology published in peer-reviewed journals during the past 10 years were identified using Medline/PubMed searches, and reviewed using the structure of WHO's stroke component of the WHO InfoBase. WHO estimates for stroke incidence and prevalence for each country were calculated from routine mortality statistics. Rates from studies that met the 'ideal' criteria were compared with WHO's estimates. Forty-four incidence studies and 12 prevalence studies were identified. There were several methodological differences that hampered comparisons of data. WHO stroke estimates were in good agreement with results from 'ideal' stroke population studies. According to the WHO estimates the number of stroke events in these selected countries is likely to increase from 1.1 million per year in 2000 to more than 1.5 million per year in 2025 solely because of the demographic changes. Until better and more stroke studies are available, the WHO stroke estimates may provide the best data for understanding the stroke burden in countries where no stroke data currently exists. A standardized protocol for stroke surveillance is recommended.
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Affiliation(s)
- T Truelsen
- World Health Organization, Geneva, Switzerland.
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Gutiérrez-Nicuesa L, Magaz-Marqués S, Badia-Llach X. [Inspection validation of prescription: guaranteeing proper use of medicines or a cost-control measure?]. Aten Primaria 2006; 37:278-86. [PMID: 16595100 PMCID: PMC7676057 DOI: 10.1157/13086315] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess the views of primary care physicians (PCPs) in Spain regarding the purpose of inspection validation of prescriptions (IVP) and its impact on prescription and patients, as well as doctors' acceptance of this measure. DESIGN Cross-sectional study through a telephone survey. SETTING Primary care centres. PARTICIPANTS PCPs prescribing oral diabetes drugs requiring IVP, or who were familiar with IVP. METHODS Telephone survey conducted in October-November, 2003, of 1471 PCPs. Sample size was calculated to ensure accuracy to 10% in each autonomous region. RESULTS 91.9% of the 1600 PCPs contacted who agreed to participate in the study met the inclusion criteria. On average, they prescribed 30.6 drugs requiring IVP per month (95% CI, 28.0-33.2), requiring an additional 4.6 minutes per prescription (95% CI, 4.4-4.8). 64.7% of PCPs increased their clinical work-time for this reason. 71.3% of PCPs (95% CI, 69.0-73.6) considered IVP an obstacle when prescribing a drug that requires it and 44.5% (95% CI, 42.0-47.0) believed that the IVP puts patients' right to receive the appropriate treatment at risk. PCPs considered that inspectors refuse authorization of their prescriptions requiring IVP for administrative (43.3%), economic (36.5%), or clinical (13.2%) reasons. 87.1% of PCPs stated that medical prescription is a sufficient control system and that IVP is not necessary for medicines for diseases managed in primary care such as Type-2 DM. 76.2% believed that the health authorities imposed the IVP requirement for some oral diabetes drugs in order to control expenditure on drugs, and 75.4% supported its withdrawal. CONCLUSION According to PCPs, the objective of the IVP is mainly economic and may affect negatively their clinical practice and patients. Therefore, in general, they do not support it, at least for drugs for diseases mainly managed in primary care.
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Affiliation(s)
| | | | - X. Badia-Llach
- Correspondencia: X. Badia-Llach. Avda. Diagonal, 618, 1.° C. 08021 Barcelona. España.
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