Purpose-With the rapid international spread of interventions, there is a need to understand the economic implications of these changes and to interpret these economic implications on the international level. The purpose of this study is to systematically compare total health care expenditures on stroke, the costs of stroke per capita, and the distribution of stroke costs within different countries, with special attention to the allocation of resources among different health care facilities. Methods-Studies for this literature review were selected by conducting a literature search from January 1966 to July 2003. Key methodological, country-related, and monetary issues of the selected stroke cost studies were evaluated using a checklist. Results-After selection, 25 stroke cost studies were reviewed. Although the selected cost of illness studies used different methodologies, the estimated expenditures for stroke are approximately similar. The proportion of national health care in the 8 countries studied is unequivocal for the more recent studies, ie, Ϸ3% of total health care expenditures. A shift is observed from the inpatient treatment costs (in the first year) toward outpatient treatment and long-term care costs (in the latter years). Furthermore, it is remarkable that in the studies, little attention is paid to costs borne by the patient and family or to the costs of comorbidity. Key Words: cost and cost analysis Ⅲ internationality Ⅲ health resources S troke is a major disease in both medical and economic terms. The prevailing emphasis on cost containment and managed care has led to increased interest in the economic aspects of stroke. A total overview of the economic aspects of stroke is given in cost of illness (COI) studies. Results of these COI studies can be used for resource allocation purposes. Over the years, there has been a marked increase in the number of these publications on the economic aspects of stroke. [1][2][3] With the rapid international spread of new diagnostic interventions and care arrangements for stroke, there is a need to understand the economic implications of these changes and to interpret these economic implications on the international level. This article aims to systematically compare how the costs of stroke in different countries are affected by cross-national differences by using a quality checklist. No complete systematic international review of the quality of COI studies in stroke has been undertaken in the literature, although efforts 2-4 have been made to illustrate the economic implication of stroke. The following study is a further elaboration of these earlier reviews. The purpose of this study is to present an international comparison of the total health care expenditures on stroke, the costs of stroke per capita, and the distribution of stroke costs within different countries, with special attention to the allocation of resources among different health care facilities. Conclusions-This

Background and Purpose-In the near future, the number of stroke patients and their related healthcare costs are expected to rise. The purpose of this study was to estimate this expected increase in stroke patients in the Netherlands. We sought to determine what the future developments in the number of stroke patients due to demographic changes and trends in the prevalence of smoking and hypertension in terms of the prevalence, incidence, and potential years of life lost might be. Methods-A dynamic, multistate life table was used, which combined demographic projections and existing stroke morbidity and mortality data. It projected future changes in the number of stroke patients in several scenarios for the Dutch population for the period 2000 to 2020. The model calculated the annual number of new patients by age and sex by using incidence rates, defined by age, sex, and major risk factors. The change in the annual number of stroke patients is the result of incident cases minus mortality numbers. Results-Demographic changes in the population suggest an increase of 27% in number of stroke patients per 1000 in 2020 compared with 2000. Extrapolating past trends in the prevalence of smoking behavior, hypertension, and stroke incidence resulted in an increase of 4%. Conclusions-The number of stroke patients in the Netherlands will rise continuously until the year 2020. Our study demonstrates that a large part of this increase in the number of patients is an inevitable consequence of the aging of the population.

To contribute to evidence-based policy making, a dynamic Dutch population model of chronic obstructive pulmonary disease (COPD) progression was developed.The model projects incidence, prevalence, mortality, progression and costs of diagnosed COPD by the Global Initiative for Chronic Obstructive Lung Disease-severity stage for 2000-2025, taking into account population dynamics and changes in smoking prevalence over time. It was estimated that of all diagnosed COPD patients in 2000, 27% had mild, 55% moderate, 15% severe and 3% very severe COPD. The severity distribution of COPD incidence was computed to be 40% mild, 55% moderate, 4% severe and 0.1% very severe COPD. Disease progression was modelled as decline in forced expiratory voume in one second (FEV1) % predicted depending on sex, age, smoking and FEV1 % pred. The relative mortality risk of a 10-unit decrease in FEV1 % pred was estimated at 1.2. Projections of current practice were compared with projections assuming that each year 25% of all COPD patients receive either minimal smoking cessation counselling or intensive counselling plus bupropion.In the projections of current practice, prevalence rates between 2000-2025 changed from 5.1 to 11 per 1,000 inhabitants for mild, 11 to 14 per 1,000 for moderate, 3.0 to 3.9 per 1,000 for severe and from 0.5 to 1.3 per 1,000 for very severe COPD. Costs per inhabitant increased from J1.40 to 3.10 for mild, J6.50 to 9.00 for moderate, J6.20 to 8.50 for severe and from J3.40 to 9.40 for very severe COPD (price level 2000). Both smoking cessation scenarios were cost-effective with minimal counselling generating net savings.In conclusion, the chronic obstructive pulmonary disease progression model is a useful instrument to give detailed information about the future burden of chronic obstructive pulmonary disease and to assess the long-term impact of interventions on this burden. KEYWORDS: Chronic obstructive pulmonary disease, cost-effectiveness, disease severity, epidemiology, model, smoking cessation W orldwide, the increase in the prevalence, morbidity, mortality and costs of chronic obstructive pulmonary disease (COPD) that has been projected for future decades [1][2][3] has drawn the attention of healthcare policy makers. They realise that slowing down disease progression is one way to reduce the increasing healthcare costs, as there is a strong association between use of healthcare services and disease severity [4][5][6][7]. Currently the only available intervention proven to slow down disease progression before patients develop severe COPD is smoking cessation. The Lung Health Study (LHS) demonstrated that COPD patients who quit smoking had an improvement in lung function in the first year, and a subsequent rate of decline that was half the rate observed among continued smokers [8].To project the future burden of COPD in The Netherlands by disease severity and to evaluate the impact of different smoking cessation interventions on the national burden of COPD, a population model has been developed that sim...

To contribute to evidence-based policy making, a dynamic Dutch population model of chronic obstructive pulmonary disease (COPD) progression was developed.The model projects incidence, prevalence, mortality, progression and costs of diagnosed COPD by the Global Initiative for Chronic Obstructive Lung Disease-severity stage for 2000-2025, taking into account population dynamics and changes in smoking prevalence over time. It was estimated that of all diagnosed COPD patients in 2000, 27% had mild, 55% moderate, 15% severe and 3% very severe COPD. The severity distribution of COPD incidence was computed to be 40% mild, 55% moderate, 4% severe and 0.1% very severe COPD. Disease progression was modelled as decline in forced expiratory voume in one second (FEV1) % predicted depending on sex, age, smoking and FEV1 % pred. The relative mortality risk of a 10-unit decrease in FEV1 % pred was estimated at 1.2. Projections of current practice were compared with projections assuming that each year 25% of all COPD patients receive either minimal smoking cessation counselling or intensive counselling plus bupropion.In the projections of current practice, prevalence rates between 2000-2025 changed from 5.1 to 11 per 1,000 inhabitants for mild, 11 to 14 per 1,000 for moderate, 3.0 to 3.9 per 1,000 for severe and from 0.5 to 1.3 per 1,000 for very severe COPD. Costs per inhabitant increased from J1.40 to 3.10 for mild, J6.50 to 9.00 for moderate, J6.20 to 8.50 for severe and from J3.40 to 9.40 for very severe COPD (price level 2000). Both smoking cessation scenarios were cost-effective with minimal counselling generating net savings.In conclusion, the chronic obstructive pulmonary disease progression model is a useful instrument to give detailed information about the future burden of chronic obstructive pulmonary disease and to assess the long-term impact of interventions on this burden. KEYWORDS: Chronic obstructive pulmonary disease, cost-effectiveness, disease severity, epidemiology, model, smoking cessation W orldwide, the increase in the prevalence, morbidity, mortality and costs of chronic obstructive pulmonary disease (COPD) that has been projected for future decades [1][2][3] has drawn the attention of healthcare policy makers. They realise that slowing down disease progression is one way to reduce the increasing healthcare costs, as there is a strong association between use of healthcare services and disease severity [4][5][6][7]. Currently the only available intervention proven to slow down disease progression before patients develop severe COPD is smoking cessation. The Lung Health Study (LHS) demonstrated that COPD patients who quit smoking had an improvement in lung function in the first year, and a subsequent rate of decline that was half the rate observed among continued smokers [8].To project the future burden of COPD in The Netherlands by disease severity and to evaluate the impact of different smoking cessation interventions on the national burden of COPD, a population model has been developed that sim...