Abstract
An international review of the costs of stroke was conducted to explore data sources, and cost variables as well as to compare estimates of the annual aggregated cost (prevalence-based) and total per patient long-term cost (incidence-based) of care.
Dutch, English, French, German, Italian and Spanish literature was searched using the keywords stroke, ischaemic stroke, haemorrhagic stroke, cerebrovascular accident, cerebral infarction, cost(s), economics, and cost analysis. Criteria for study inclusion were: provides estimates of direct and/or indirect costs of stroke, published after 1989, methods described in adequate detail, and for studies of long-term costs, estimates based on a minimum 5 years of care following the event. Cost estimates are presented in original currencies and US dollars.
Among studies representing Australia, New Zealand, Western Europe and North America, six prevalence studies reported total annual aggregated costs of $US7975 (1988 values) to $US54 546 (1993 values) per patient; eight incidence-based studies reported total long-term per patient costs of $US18 538 (1991 values) to $US228 038 (1990 values). Identifiable factors underlying variation included: perspective employed, cost variables considered, and exclusion of comorbidities.
Although lack of uniformity hampers inter-study comparisons, it is evident that stroke poses a significant economic burden. Consensus on standard cost variables and methods for projections of resource use and survival over time are clearly warranted.
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Notes
Total greater than the number of papers excluded (67) because each paper could be excluded for more than one reason.
References
National Stroke Association. The brain at risk: understanding and preventing stroke. Englewood (CO): National Stroke Association, 1996
Haidinger G, Waldhoer T, Tuomilehto J, et al. Assessment of costs related to hospitalization of stroke patients inAustria for 1992 and prospective costs for the year 2010. Cerebrovasc Dis 1996; 7: 163–7
Rice DP. Cost-of-illness studies: fact or fiction? Lancet 1994; 344: 1519–20
Caro JJ, Huybrechts KF, for the Stroke Economic Analysis Group. Stroke treatment economic model (STEM): predicting long-term costs from functional status. Stroke 1999; 30: 2574–9
Isard PA, Forbes JF. The cost of stroke to the National Health Service in Scotland. Cerebrovasc Dis 1992; 2: 47–50
Matchar DB, Duncan PW. Cost of stroke. Stroke Clin Updates 1994; 5 (3): 9–12
Scott WG, Scott H. Ischaemic stroke in New Zealand: an economic study. N Z Med J 1994; 107: 443–6
Chan B, Hayes B. Cost of stroke in Ontario, 1994/95. CMAJ 1998; 159 Suppl. 6: S2–7
Evers SMAA, Engel GL, Ament AJHA. Cost of stroke in The Netherlands from a societal perspective. Stroke 1997; 28: 1375–81
Bergman L, van der Meulen JHP, Limburg M, et al. Costs of medical care after first-ever stroke in The Netherlands. Stroke 1995; 26: 1830–6
Fagan SC, Morgenstern LB, Petitta A, et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. Neurology 1998; 50: 885–90
Kaste M, Fogelholm R, Rissanen A. Economic burden of stroke and the evaluation of new therapies. Public Health 1998; 112: 103–12
Lightowlers S, McGuire A. Cost-effectiveness of anticoagulation in non-rheumatic atrial fibrillation in the primary prevention of ischemic stroke. Stroke 1998; 29: 1827–32
Persson U, Silverberg R, Lindgren B, et al. Direct costs of stroke for a Swedish population. Int J Technol Assess Health Care 1990; 6: 125–37
Taylor TN, Davis PH, Torner JC, et al. Lifetime costs of stroke in the United States. Stroke 1996; 27: 1459–66
Terént A, Marké LA, Asplund K, et al. Costs of stroke in Sweden: a national perspective. Stroke 1994; 25: 2363–9
Caro JJ, Huybrechts KF, Klittich WS. The “big mac index” for healthcare: a solution to extrapolation headaches? ISPOR News 2000; 6 (6): 8
Public accounts of Ontario, 1994–95. Toronto: Ontario Ministry of Finance, 1995
Terént A. Increasing incidence of stroke among Swedish women. Stroke 1988; 19: 598–603
Terént A. Survival after stroke and transient ischemic attacks during the 1970s and the 1980s. Stroke 1989; 20: 1320–6
Sacco RL, Sni T, Zamanuie MC, et al. Predictors of mortality and recurrence after hospital cerebral infarction in an urban community: the northern Manhattan stroke study. Neurology 1994; 44: 626–34
Sacco RL, Wolf PA, Kannel WB, et al. Survival and recurrence after stroke: the Framingham study. Stroke 1982; 13: 290–5
Bamford JM, Sandercock PAG, Dennis MS, et al. A prospective study of acute cerebrovascular disease in the community: the Oxfordshire Community Stroke Project 1981–86. I. Methodology, demography and incidence cases of first-ever stroke. J Neurol Neurosurg Psychiatry 1988; 51: 1373–80
Dennis MS, Burn JPS, Sandercock PAG, et al. Long-term survival after first-ever stroke: the Oxfordshire Community Stroke Project. Stroke 1993; 24: 796–800
Wolfe CDA, Taub NA, Bryan S, et al. Variations in the incidence, management and outcome of stroke in residents under the age of 75 in two health districts of Southern England. J Public Health Med 1995; 17: 441–8
US Department of Health and Human Services. Agency for Health Care and Policy Research. National medical expenditure survey, 1987; Institutional population component [various computer files]. Rockville (MD): USDHHS. AHCPR [producer], 1994. Ann Arbor (MI): International Consortium for political and social research [distributor], 1994
Porsdal V, Boysen G. Cost-of-illness studies of stroke. Cerebrovasc Dis 1997; 7: 258–63
Fischer M, Schaebitz W. An overview of acute stroke therapy: past, present and future. Arch Intern Med 2000; 160: 3196–206
Bloom BS, Bruno DJ, Maman DY, et al. Usefulness of US cost-of-illness studies in health care decision making. Pharmacoeconomics 2001; 19 (2): 207–13
Gold MR, Siegal JE, Russell LB, et al. Cost-effectiveness in health and medicine. New York (NY): Oxford University Press, 1996
Drummond ME, O’Brien B, Stoddart GL, et al. Methods for the economic evaluation of health care programmes. 2nd ed. Oxford: Oxford University Press, 1997
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Payne, K.A., Huybrechts, K.F., Caro, J.J. et al. Long Term Cost-of-Illness in Stroke. Pharmacoeconomics 20, 813–825 (2002). https://doi.org/10.2165/00019053-200220120-00002
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DOI: https://doi.org/10.2165/00019053-200220120-00002