Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

Exel, Job van; Koopmanschap, Marc; Wijngaarden, Jeroen Dh van; Reimer, W.J. Scholte op

doi:10.1186/1478-7547-1-2

Cited by 44 publications

(11 citation statements)

References 21 publications

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“…Here costs are reduced from €10,018 to €5,777, on average. This confirms earlier findings on the reduced length of stay [ 13 ].…”

Section: Resultssupporting

confidence: 93%

“…We considered the impact on informal care in this study elsewhere [ 14 ]. Costs of care for the first six months after stroke were based on patient level resource use from the EDISSE study [ 13 ], and resource costs/prices of 2003 [ 23 ]. Because length of stay at different locations was the most important cost driver during this period [ 13 ], first, inpatient costs were calculated using original length of stay data and 2003 nursing day prices.…”

Section: Methodsmentioning

confidence: 99%

“…Costs of care for the first six months after stroke were based on patient level resource use from the EDISSE study [ 13 ], and resource costs/prices of 2003 [ 23 ]. Because length of stay at different locations was the most important cost driver during this period [ 13 ], first, inpatient costs were calculated using original length of stay data and 2003 nursing day prices. Subsequently, total individual costs of care during the first six months were computed by holding the original ratio between inpatient and total costs constant, for each patient and each place of residence (hospital, nursing home, revalidation centre and home) at which the patient stayed during this period, weighted by the length of stay.…”

Section: Methodsmentioning

confidence: 99%

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Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

Baeten

Exel

Dirks

et al. 2010

Cost Eff Resour Alloc

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BackgroundEconomic evaluation of stroke services indicates that such services may lead to improved quality of life at affordable cost. The present study assesses lifetime health impact and cost consequences of stroke in an integrated service setting.MethodsThe EDISSE study is a prospective non-randomized controlled cluster trial that compared stroke services (n = 151 patients) to usual care (n = 187 patients). Health status and cost trial-data were entered in multi-dimensional stroke life-tables. The tables distinguish four levels of disability which are defined by the modified Rankin scale. Quality-of-life scores (EuroQoL-5D), transition and survival probabilities are based on concurrent Dutch follow-up studies. Outcomes are quality-adjusted life years lived and lifetime medical cost by disability category. An economic analysis compares outcomes from a successful stroke service to usual care, by bootstrapping individual costs and effects data from patients in each arm.ResultsLifetime costs and QALYs after stroke depend on age-of-onset of first-ever stroke. Lifetime QALYs after stroke are 2.42 (90% CI - 0.49 - 2.75) for male patients in usual care and 2.75 (-0.61; 6.26) for females. Lifetime costs for men in the usual care setting are €39,335 (15,951; 79,837) and €42,944 (14,081; 95,944) for women. A comparison with the stroke service results in an ICER of €11,685 saved per QALY gained (€14,211 and €7,745 for men and women respectively). This stroke service is with 90% certainty cost-effective.ConclusionsOur analysis shows the potential of large health benefits and cost savings of stroke services, taking a lifetime perspective, also in other European settings.

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“…Here costs are reduced from €10,018 to €5,777, on average. This confirms earlier findings on the reduced length of stay [ 13 ].…”

Section: Resultssupporting

confidence: 93%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

Baeten

Exel

Dirks

et al. 2010

Cost Eff Resour Alloc

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“…This is the first study that has estimated the potential public health impact of a substantial salt reduction in a single food category. Since considerable acute and long-term health care costs and productivity losses are involved with HF, stroke [ 41 ] and AMI [ 42 ], it is likely that reducing respective incident cases can significantly reduce related health care costs and productivity losses. This case study shows that a substantial and achievable salt reduction in soups in the Netherlands as part of an overall salt reduction strategy, could potentially have an impact, albeit small, on public health.…”

Section: Discussionmentioning

confidence: 99%

A Modelling Approach to Estimate the Impact of Sodium Reduction in Soups on Cardiovascular Health in the Netherlands

et al. 2015

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Hypertension is a major modifiable risk factor for cardiovascular disease and mortality, which could be lowered by reducing dietary sodium. The potential health impact of a product reformulation in the Netherlands was modelled, selecting packaged soups containing on average 25% less sodium as an example of an achievable product reformulation when implemented gradually. First, the blood pressure lowering resulting from sodium intake reduction was modelled. Second, the predicted blood pressure lowering was translated into potentially preventable incidence and mortality cases from stroke, acute myocardial infarction (AMI), angina pectoris, and heart failure (HF) implementing one year salt reduction. Finally, the potentially preventable subsequent lifetime Disability-Adjusted Life Years (DALYs) were calculated. The sodium reduction in soups might potentially reduce the incidence and mortality of stroke by approximately 0.5%, AMI and angina by 0.3%, and HF by 0.2%. The related burden of disease could be reduced by approximately 800 lifetime DALYs. This modelling approach can be used to provide insight into the potential public health impact of sodium reduction in specific food products. The data demonstrate that an achievable food product reformulation to reduce sodium can potentially benefit public health, albeit modest. When implemented across multiple product categories and countries, a significant health impact could be achieved.

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“…research [18,68] has shown that VASs provide valid Data were analyzed using SPSS (version 12.0.1). Responknown about the situation and experiences of padents answered questions about socioeconomic statients on waiting lists for nursing home or residential tus, health, well-being, intermittent care use, care care, let alone on waiting lists for home care.…”

Section: Effects Of Waiting Measures To Reducementioning

confidence: 99%

When Time is Not on Your Side

Exel¹,

Ruiter²,

Brouwer³

2008

The Patient: Patient-Centered Outcomes Research

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Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services

Cited by 44 publications

References 21 publications

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

Lifetime health effects and medical costs of integrated stroke services - a non-randomized controlled cluster-trial based life table approach

A Modelling Approach to Estimate the Impact of Sodium Reduction in Soups on Cardiovascular Health in the Netherlands

When Time is Not on Your Side

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