Cost of stroke in <scp>F</scp>rance

Chevreul, Karine; Durand‐Zaleski, Isabelle; Gouépo, A.; Féry-Lemonnier, E.; Hommel, Marc; Woimant, F.

doi:10.1111/ene.12143

Cited by 57 publications

(44 citation statements)

References 15 publications

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“…Our results for the healthcare costs of the acute and post-acute phases combined (€20,325.39 per patient) were slightly higher than those found by Chevreul et al . [2], which were €16,686 per patient in the first year for incident cases of stroke, from a societal perspective with data from 2007. Again, Chevreul et al .…”

Section: Discussionmentioning

confidence: 99%

“…French studies such as Launois et al [3] and Chevreul et al . [2] employed a similar pathway model, whereas Spieler et al [13] used slightly different post-acute pathways: convalescent home, rehabilitation, nursing home, chronic hospitalization, and ambulatory care. Finally, Ehlers et al [14] used a simpler pathway model to evaluate the cost-effectiveness of thrombolysis within a 3-hour window post-stroke in a Danish hospital: discharge to home, to rehabilitation or to a nursing home.…”

Section: Discussionmentioning

confidence: 99%

“…In France, stroke is the third leading cause of death and the foremost cause of acquired disability in adults [2]. The burden on public health and the economic impact of stroke are sizeable.…”

Section: Introductionmentioning

confidence: 99%

“…The burden on public health and the economic impact of stroke are sizeable. A recent study for the French Ministry of Health estimated the total healthcare cost of stroke patients in France at €5.3 billion per year [2]. …”

Section: Introductionmentioning

confidence: 99%

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Acute Ischemic Stroke (AIS) Patient Management in French Stroke Units and Impact Estimation of Thrombolysis on Care Pathways and Associated Costs

et al. 2015

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Background: Stroke is the second leading cause of death and a first leading cause of acquired disability in adults worldwide. This study aims to evaluate the current management and associated costs of acute ischemic stroke (AIS) for patients admitted in stroke units in France and over a one-year follow-up period as well as to assess the impact of improved thrombolytic management in terms of increasing the proportion of patients receiving thrombolysis and/or treated within 3 h from the onset of symptoms. Methods: A decision model was developed, which comprises two components: the first corresponding to the acute hospital management phase of patients with AIS up until hospital discharge, extracted from the national hospital discharge database (PMSI 2011), and the second corresponding to the post-acute (post-discharge) phase, based on national treatment guidelines and stroke experts' advice. Five post-acute clinical care pathways were defined. In-hospital mortality and mortality at 3 months post-discharge was taken into account into the model. Patient journeys and costs were determined for both phases. Improved thrombolytic management was modeled by increasing the proportion of patients receiving thrombolysis from the current estimated level of 16.7 to 25% as well as subsequently increasing the proportion of patients treated within 3 h of the onset of symptoms post-stroke from 50 to 100%. The impact on care pathways was derived from clinical data. Results: Among 202,078 hospitalizations for a stroke or a transient ischemic attack (TIA), 90,528 were for confirmed AIS, and 33% (29,999) of them managed within a stroke unit. After hospitalization, 60% of discharges were to home, 25% to rehabilitative care and then home, 2% to rehabilitative care and then a nursing home, 7% to long-term care, and 6% of stays ended with patient death. Of a total cost over 1 year of €610 million (mean cost per patient of €20,326), 70% concern the post-acute phase. By increasing the proportion of patients being thrombolyzed, costs are reduced primarily by a decrease in rehabilitative care, with savings per additional treated patient of €1,462. By adding improved timing, savings are more than doubled (€3,183 per additional treated patient). Conclusions: This study confirms that the burden of AIS in France is heavy. By improving thrombolytic management in stroke units, patient journeys through care pathways can be modified, with increased discharges home, a change in post-acute resource consumption and net savings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acute Ischemic Stroke (AIS) Patient Management in French Stroke Units and Impact Estimation of Thrombolysis on Care Pathways and Associated Costs

et al. 2015

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“…The reliability of PMSI data has already been assessed, 17,18 and PMSI has previously been used to study patients with stroke, myocardial infarction, and AF. [19][20][21] The study population comprised adults with a diagnosis of acute ischemic stroke (I63 and its subsections using International Classification of Diseases, Tenth Revision codes) coded in the principal diagnosis (ie, the health problem that justified admission to hospital), the related diagnosis (ie, potential chronic disease or health state during hospital stay), or the significantly associated diagnosis (ie, comorbidity or associated complication) who were hospitalized from January 1 to December 31, 2009. Of note, asymptomatic cerebrovascular diseases and sequelae of stroke have different codes (I65-I66 and I69 with subdivisions) to be distinguished from acute strokes in the patients of our analysis.…”

Section: Selection Of Patientsmentioning

confidence: 99%