Indirect Costs Of Stroke Research Articles

Cardiovascular Stroke Prevention and Management Using the Principles of Cellular Medicine

Cerebrovascular disease generally refers to the abnormality of the brain, and it is usually caused by the pathologic process of blood vessels. After heart disease and cancer, stroke is the third most common cause of death in the developed world. Stroke can be classified based on the evolution and duration of the symptoms experienced by the patient. From the perspectives of human, family, and the society, stroke is a costly disease. In 2015, the total cost of stroke in the EU was estimated at about €45 Billion. Also, in the same year, the total direct and indirect cost of stroke in the United States of America was calculated as $103.50 billion annually. Meanwhile, stroke can be conveniently classified as two processes, based on pathologic anatomy and pathophysiology. The first process is; hpoxia, ischaemia, and infarction. This is usually caused by the pathology of blood supply and the impairment of oxygenation to the central nervous system (CNS) tissue. The second process is haemorrhage, and this is usually due to the rupture of blood vessels to the CNS. Most of the thrombotic arterial occlusions are caused by atherosclerosis, while primary brain parenchymal haemorrhage is most commonly due to hypertension. Cellular medicine is an approach to healthcare which focuses on the aetiology of diseases and develops treatment for the diseases by studying; biological processes, structures and functions of biomolecules, and cell physiology, in order to understand abnormal biological function at the cellular level. Research in the field of cellular medicine have revealed that atherosclerosis, the main cause of cardiovascular and cerebrovascular diseases, can be reversed using cellular medicine. The research also showed that atherosclerosis is an early form of full blown scurvy, thus both scurvy and atherosclerosis have the same cause, which is vitamin C deficiency.

Abstract 73: The True Cost of Stroke: Assessment of Direct and Indirect Cost of Stroke Among All Age Groups in United States of America From 2003 to 2014

Introduction: Researchers have looked at medical expenses directly associated with stroke care, however, there is a paucity of data regarding indirect costs associated with productivity loss, especially in young adults. Methods: Direct and indirect medical costs were compared between stroke and non-stroke patients using the 2003-2014 Medical Expenditure Panel Survey-Household components. Direct costs include expenditures from hospitalizations, emergency room/clinic visits, medications, home health services etc. Indirect costs depend on employment, wages, missed work days (limited to 18-64 age group), and productivity loss from premature death. Two-part econometric models were used to estimate the adjusted incremental direct expenditure for patients with stroke. We used a generalized linear model with family gamma, log link for the adjusted analysis of annual wage and a negative binomial regression model for the adjusted analysis of missed work day. Loss of productivity due to premature death was computed across all age groups using Present value of one life and annual number of deaths obtained from the 2014 National Vital Statistics. Results: We identified 8,101,160 stroke and 245,133,892 non-stroke patients of all age groups. Weighted samples of 10,175 stroke and 314,694 non-stroke patients were compared. Total adjusted incremental direct cost for a stroke patient (vs. non-stroke) was $4,317 (95% CI $3,828-4,807) causing a $35 billion increment in total direct cost annually. Stroke patients had $14,254 (95% CI $16,023-12,485) lower adjusted annual wage, 4.2 (95% CI 2.9-5.6) more missed workdays and nearly 60% (OR 0.41; 95% CI 0.36-0.46) lower employment compared to non-stroke patients yielding an estimated annual $38.1 billion indirect-cost due to productivity loss. Indirect-cost from premature death was estimated to be $30.4 billion. Total (direct + indirect) annual cost for stroke patients was $103.5 billion. Conclusion: Two-thirds of the estimated $103.5 billion annual cost involved with stroke patients is attributed to indirect expenditures. Loss of productivity due to premature death is heavily concentrated in the economically productive age group. Our findings renew the call for greater emphasis on stroke prevention strategies.

PCV66 - Indirect Costs of Stroke in Turkey

PCV66 - Indirect Costs of Stroke in Turkey

Cost of stroke: a controlled national study evaluating societal effects on patients and their partners.

BackgroundTo estimate the direct and indirect costs of stroke in patients and their partners.DescriptionDirect and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients and compared with 364,433, 103,741 and 500,490 matched controls, respectively.ResultsIndependent of age and gender, stroke patients had significantly higher rates of mortality, health-related contacts, medication use and lower employment, lower income and higher social-transfer payments than controls. The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls for hemorrhagic, ischemic and unspecified stroke, respectively. The negative social- and health-related status could be identified up to eleven years before the first diagnosis.ConclusionStroke has significant mortality, morbidity and socioeconomic consequences for patients, their partners and society.

Obstacles and Solutions in the Implementation of Telestroke

The American Heart Association in its 2013 Stroke Statistics Update1 reports the annual direct and indirect costs of stroke in the United States to be $62.7 billion, with 15% to 30% of stroke survivors being permanently disabled and 20% requiring institutional care at 3 months after stroke. Rapid recognition and accurate diagnosis are critical to optimize outcomes in patients with acute stroke. Patients treated within 90 minutes of stroke onset with the thrombolytic tissue-type plasminogen activator (tPA) have increased odds of improvement at 24 hours and favorable 3-month outcomes compared with patients treated later than 90 minutes.2,3 Timely thrombolytic treatment also substantially lowered the long-term costs of stroke.4 In the United States, there are ≈4 neurologists per 100 000 people, caring for >700 000 acute strokes per year,5 although many parts of the United States lack access to acute stroke services entirely.6 Telemedicine provides a means to increase access to limited specialty expertise and facilitate timely remote neurological assessment, neuroimaging evaluation, and therapeutic decision making for patients with acute stroke. In its 2009 Scientific Statement, which reviewed evidence for the use of telemedicine within Stroke Systems of Care, the American Heart Association/American Stroke Association “recommended that a stroke specialist using high-quality videoconferencing provide a medical opinion in favor of or against the use of tPA in patients with suspected acute ischemic stroke when on-site stroke expertise is not immediately available.”7 In making this class 1 recommendation, the American Heart Association/American Stroke Association cited studies that showed increased rate of tPA treatment and good functional outcomes at telestroke network hospitals. The TEMPiS project established high-quality videoconferencing services to a network of 12 regional hospitals in Bavaria serviced by 2 stroke centers.8 It reported a 10-fold relative increase in tPA treatments at telestroke …

Abstract 208: A Literature Review Of Indirect Cost Of Stroke

Background: Stroke is not only a costly deadly disease, but also a leading cause of long-term disability. However, stroke associated indirect costs such as productivity loss and informal care cost have not been well studied. To better develop such studies and provide policy-relevant information, we conducted a literature review of indirect costs of stroke. Methods: We conducted a literature search using PubMed, MEDLINE and EconLit, complemented by Google Scholar search and cross-reference checking using key words of stroke, cerebrovascular disease, subarachnoid hemorrhage, intracerebral hemorrhage, cost of illness, productivity loss, indirect cost, economic burden, and informal caregiving. We identified original research articles published during 1990-2012 in English language peer reviewed journals for the review. Since the number of studies on indirect cost of stroke was small, we included cost-of-illness (COI) studies if they contained sufficient analyses of the indirect cost. We summarized the indirect costs by study type, cost categories, and study settings. Results: There were 31 original research articles investigating the indirect cost of stroke. Only 6 (19%) of these studies solely investigated the indirect cost; the other 25 (81%) studies were COI studies which included the indirect cost as a component. Of the 31 articles, six examined indirect costs in the US. Two of them focused solely on indirect costs. One study at a national level examined informal caregiving among elderly with stroke and estimated the annual cost of such care to be $6.1 billion in 1999. The other study for the State of California estimated lost productivity associated with stroke mortality in the State to be over $1 billion in 1991. The other four US studies suggested that the indirect costs will continue to increase in the coming decades, especially among African American and Hispanics, and that indirect costs might account for over 58% of the total cost of stroke. Due to diverse research methods, data, and cost definitions, the literature suggested a wide range of the indirect cost as a percentage of total stroke costs (2.6% - 71%) often with indirect cost as a significant cost component of stroke. Conclusions: While the literature indicated that the indirect cost accounted for a significant portion of the economic burden of stroke, there is a clear need to develop improved methods to study costs and to better use or establish relevant data sources for such studies. With the aging population and increasing survival rate of stroke, both direct and indirect costs of stroke are likely to increase greatly. Interventions for stroke prevention as well as for improving quality of life among stroke patients are needed to contain both direct and indirect costs associated with stroke. More research investigating the indirect costs will be helpful in guiding the development of such interventions to reduce the burden of stroke.

Abstract WMP93: Uninsured Patients have Longer Hospital Stays and are Less Likely to Receive Rehab than Insured Patients

Background: In 2010 the estimated direct and indirect cost of stroke was $53.9 billion. The long-term burden to society is thought to be much more costly. Whether or not this sum can be reduced has been a subject of great debate. Recently, healthcare reform has been a priority for policy makers with health insurance as a prevailing issue. We examined the healthcare records of patients in the US who presented with stroke symptoms in a 10-year period from 2001-2011, and compared them to patients in the state of Arizona as well as our University Hospital in the same time period. We then looked for differences in the cost of stroke with regard to variations in insurance status. Methods: The records of 978,813 patients with stroke symptoms in the US from January 2001 through December 2011 were compared with 18,875 Arizona (AZ) patients. This data was evaluated and compared with data obtained from the records of 1,123 patients admitted to the University Medical Center (UMC), and separated by insurance status, discharge location and length of stay (LOS) for different stroke subtypes. The information was gathered from the get with the guidelines stroke database and only included hospitals that reported their information. Results: The mean LOS for stroke patients in the US, AZ and UMC were: 5.25 days, 4.69 and 4.75 days, respectively. When separated by insurance status, the mean LOS for patients at UMC with Medicare was 4.27 days (n=470), for Medicaid it was 6.17 days (n=150) and 5.13 days (n=464) for private insurance. Compared with insured patients, uninsured patients had a LOS of 8.18 days (n=39; p=.001). Uninsured patients were discharged home without rehab 24.4% of the time compared with only 8.8% of insured patients (p=.001), even though 93.5% of uninsured patients were considered for rehab. Conclusion: Uninsured patients had a LOS that was 3.3 days longer than insured patients and had an estimated 72% higher cost of hospitalization. Uninsured patients were almost 3 times less likely than insured patients to be discharged with rehab, and consequently were less likely to achieve long-term functional independence. Ultimately, the price of stroke in the uninsured is paid for by taxpayers, since these patients will require social services granted by the government for disability.

Randomized Clinical Stroke Trials in 2009

Problem statement: Stroke ranks as the leading cause of serious, long-term disability and death world-wide. It is estimated direct and indirect cost of stroke for 2009 was $68.9 billion. Approach: The objective of this review was to examine the effectiveness of emerging pharmacotherapy’s in patients with acute (≤2 weeks), sub-acute (2-12 weeks) and chronic (≥12 weeks) stroke studied in Randomized Control Trials (RCT’s) published in 2009. Medline search was performed to identify all RCT’s in acute, sub-acute and chronic stroke treatment in the year 2008. The search strategy used for Pub Med included key words such as Randomized Controlled Trials (RCT), Stroke OR cerebrovascular disorders OR CVA, Ischemic stroke OR ischemia, Hemorrhage OR intraparenchymal hemorrhage OR subarachnoid hemorrhage, Thrombolytics OR tissue plasminogen activator OR alteplase OR t-PA, Diabetes mellitus OR hyperglycemia, Hypertension OR raised blood pressure, Aspirin OR anti-platelets, Warfare OR anticoagulant, Antidepressants , Neuroprotectants and Coiling OR stents OR endovascular. Search limits included Human, Adult (age>19 years), English language and Publication date: 1/1/2009-12/31/2009. Results: Eleven categories of 27 RCT’s were found and analyzed. Conclusion: There was sufficient evidence to suggest that: (1) extending the time-window for administration of desmoteplase between 3-9 h after ischemic stroke onset did not improve clinical outcome; (2) at present neither lidocaine, erythropoietin or ropinotan had been effective neuroprotective agents in ischemic stroke; (3) treatment with dabigatran was associated with lower rate of stroke and systemic embolism in patients with non-valvular aerial fibrillation; (4) memantine and constraint-induced aphasia therapy were able to reduce the severity of aphasia in chronic post-stroke aphasia and (5) percutaneous closure of the left aerial appendage can be an effective alternative to chronic warfare treatment.

Randomized Clinical Stroke Trials In 2008

Problem statement: Stroke ranks as the third leading cause of death and the leading cause of serious, long-term disability; estimated direct and indirect cost of stroke for 2009 was $68.9 billion. Approach: The objective of this review was to examine the effectiveness of emerging pharmacotherapies in patients with acute (≤2 weeks), sub-acute (2-12 weeks) and chronic (≥12 weeks) stroke studied in Randomized Control Trials (RCT's) published in 2008. Medline search was performed to identify all RCT’s in acute, sub-acute and chronic stroke treatment in the year 2008. The search strategy used for PubMed included key words such as Randomized Controlled Trials (RCT), Stroke OR cerebrovascular disorders OR CVA, Ischemic stroke OR ischemia, Hemorrhage OR intraparenchymal hemorrhage OR subarachnoid hemorrhage, Thrombolytics OR tissue plasminogen activator OR alteplase OR t-PA, Diabetes mellitus OR hyperglycaemia, Hypertension OR raised blood pressure, Aspirin OR anti-platelets, Warfarin OR anticoagulant, Antidepressants, Neuroprotectants and Coiling OR stents OR endovascular. Search limits included Human, Adult (age >19 years), English language and Publication date: 1/1/2008 to 12/31/2008. Results: Eleven categories of 21 RCT’s were found and analyzed. Conclusion/Recommendations: There is sufficient evidence to suggest that: (1) extending the time-window for administration of alteplase from 3-4.5 h after stroke onset does improve clinical outcome; (2) treatment of hypertension in the elderly does reduce rate of stroke, cardiac failure and death from stroke and (3) at present there are no neuroprotectants on the horizon.

Primary Prevention of Stroke

After heart disease, stroke is the second leading cause of death worldwide in persons ≥15 years of age.1 Stroke was responsible for an estimated 5.7 millions deaths in 2005, with ≈87% of the deaths occurring in low- and middle-income countries. It is the fourth leading cause of disease burden as determined by disability-adjusted life-years. In the United States, stroke caused an estimated 1 in 16 deaths in 2004; ≈780 000 new or recurrent strokes occurred; and 15% to 30% of stroke survivors were permanently disabled.2 In the United States in 2008, the direct and indirect cost of stroke is estimated to be $65.5 billion. Globally, stroke death is anticipated to rise to 6.5 million in 2015 and 7.8 million in 2030.1 Although stroke poses a major public health challenge, it is preventable.3 Observational epidemiological studies and clinical trials have laid the groundwork for well-developed evidence-based stroke prevention guidelines. Article p 947 The INTERHEART study helped to clarify the role of traditional cardiovascular risk factors in coronary heart disease among 15 152 cases of acute myocardial infarction and 14 820 controls in 52 countries on every inhabited continent.4 This important observational epidemiological study showed that for men and women, old and young, and in all areas of the world, 9 potentially modifiable factors accounted for >90% of the proportion of the risk of initial acute myocardial infarction. The factors were abnormal lipids; smoking; hypertension; diabetes; abdominal obesity; psychosocial factors; consumption of fruits, vegetables, and alcohol; and regular physical activity. Because coronary heart disease and stroke share common risk factors,5 a combination of healthy lifestyle factors also might influence stroke risk. There has been a relatively paucity of information, however, in this area of study. In this issue of Circulation , Chiuve et al6 report …

Current Status of Carotid Stenting

Stroke is the third most common cause of death worldwide following ischemic heart disease and cancer and the number one condition associated with permanent disability. In Western countries, the yearly incidence of stroke is approximately 0.2% of the population and the number of stroke-related death is expected to double over the next 30 years. Studies from the Netherlands and Scotland showed that stroke accounted for 3% to 5% of their total health care resources. For 2006, the estimated direct and indirect cost of stroke in the United States was approximately 60 billion. Significant stenosis of the internal carotid artery is responsible for 10% to 20% of all strokes or transient ischemic attacks. Large-scale randomized clinical trials have established the superiority of carotid endarterectomy (CEA) over medical management in patients with high-grade stenosis of the internal carotid artery, particularly among symptomatic patients. Although percutaneous carotid revascularization has been performed since the early eighties, the enthusiasm has long been tempered by the fear of cerebral embolism. Following the introduction of emboli protection devices (EPD) around the year 2000, the number of procedures performed worldwide has grown exponentially. We review the available studies on carotid stenting and discuss appropriate use of this procedure. Emphasis is also placed on optimal long-term pharmacotherapy in patients with carotid stenosis.

Cost of stroke in Sweden: an incidence estimate.

To estimate the excess cost of stroke in Sweden and the potential costs that could be avoided by preventing first-ever strokes. We adopted the incidence approach for estimating the present value of both direct and indirect costs. Data on mortality, stroke recurrence, and inpatient care were estimated from a national register of patient data with a four-year follow-up period. To estimate costs for social services, we used survey data on living conditions before stroke onset and at three and at twenty-four months. Costs for outpatient visits, rehabilitation, drugs, and production losses due to premature death and early retirement were estimated on the basis of both published and nonpublished sources. Lifetime costs were based on life tables adjusted for excess mortality of stroke, and costs in year 4 were extrapolated to subsequent years. The present value direct cost for an average stroke patient is SEK513,800 (USdollars 56,024 or Euro60,825). The corresponding indirect cost is SEK125,110 (USdollars13,640 or Euro14,810). Almost 45 percent of the direct costs were attributable to social services. Women had higher costs than men, and costs for survivors increased with age due to social services. With an incidence of 213 first-ever strokes per 100,000 individuals, the total excess direct and indirect cost of stroke would be SEK12.3 billion (approximately US$1.3 billion or Euro1.5 billion). Hence, there are large potential cost offsets both in the health-care sector and in the social service sector if the incidence of first-ever stroke could be reduced.

Long term cost-of-illness in stroke: an international review.

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 US dollars 7,975 (1988 values) to US dollars 54,546 (1993 values) per patient; eight incidence-based studies reported total long-term per patient costs of US dollars 18,538 (1991 values) to US dollars 228,038 (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.

Costs of stroke in Sweden. A national perspective.

Cost-effectiveness analyses of stroke management are hampered by paucity of economic data. We made an update of the direct and indirect costs of stroke in Sweden (population, 8.5 million). Direct costs (ie, the costs for hospital and outpatient care and social services) were estimated on the basis of two prospective population-based studies of stroke and of two nationwide cross-sectional inventories of bed-days and diagnoses. Indirect costs (ie, the costs for loss of productivity and early retirement) were based on official statistics. The direct annual costs of care for stroke patients in 1991 equaled 7836 million Swedish krona (SKr) ($1306 million in US dollars), and the indirect costs, 2430 million SKr ($405 million). The cost of stroke care was 1208 SKr ($201) per inhabitant in Sweden. The expected direct costs per patient from first stroke to death were 440,000 SKr ($73,333). When prestroke costs for other diseases and advanced age were subtracted, the sum was reduced to 180,000 SKr ($30,000). Costs for hospital and outpatient care and social services accounted for 76% of Swedish stroke costs and for 24% of costs for loss of production and early retirement. Only 41% of direct costs were stroke-related.