Estimated societal costs of stroke in the UK based on a discrete event simulation

Patel, Anita; Berdunov, Vladislav; Quayyum, Zahidul; King, Derek; Knapp, Martin; Wittenberg, Raphael

doi:10.1093/ageing/afz162

Cited by 96 publications

(68 citation statements)

References 18 publications

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“…Diringer et al [ 20 ] also found old age, heart problem, male sex, the severity of the stroke, and hospitalisation as predictors of ischemic stroke hospital costs. Similar findings were revealed by a study done in the UK, which found that the mean stroke costs were higher in females aged between 75 and 84 years [ 21 ]. A study conducted in the Netherlands established that hospitalisation costs contributed a larger proportion to total stroke costs and age was significantly associated with stroke costs [ 22 ].…”

Section: Discussionsupporting

confidence: 90%

Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression

Matizirofa

Chikobvu

2021

BMC Public Health

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Background In South Africa (SA), stroke is the second highest cause of mortality and disability. Apart from being the main killer and cause of disability, stroke is an expensive disease to live with. Stroke costs include death and medical costs. Little is known about the stroke burden, particularly the stroke direct costs in SA. Identification of stroke costs predictors using appropriate statistical methods can help formulate appropriate health programs and policies aimed at reducing the stroke burden. Analysis of stroke costs have in the main, concentrated on mean regression, yet modelling with quantile regression (QR) is more appropriate than using mean regression. This is because the QR provides flexibility to analyse the stroke costs predictors corresponding to quantiles of interest. This study aims to estimate stroke direct costs, identify and quantify its predictors through QR analysis. Methods Hospital-based data from 35,730 stroke cases were retrieved from selected private and public hospitals between January 2014 and December 2018. The model used, QR provides richer information about the predictors on costs. The prevalence-based approach was used to estimate the total stroke costs. Thus, stroke direct costs were estimated by taking into account the costs of all stroke patients admitted during the study period. QR analysis was used to assess the effect of each predictor on stroke costs distribution. Quantiles of stroke direct costs, with a focus on predictors, were modelled and the impact of predictors determined. QR plots of slopes were developed to visually examine the impact of the predictors across selected quantiles. Results Of the 35,730 stroke cases, 22,183 were diabetic. The estimated total direct costs over five years were R7.3 trillion, with R2.6 billion from inpatient care. The economic stroke burden was found to increase in people with hypertension, heart problems, and diabetes. The age group 55–75 years had a bigger effect on costs distribution at the lower than upper quantiles. Conclusions The identified predictors can be used to raise awareness on modifiable predictors and promote campaigns for healthy dietary choices. Modelling costs predictors using multivariate QR models could be beneficial for addressing the stroke burden in SA.

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Section: Discussionsupporting

confidence: 90%

Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression

Matizirofa

Chikobvu

2021

BMC Public Health

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“…Conversely, long term worklessness has been linked to increased risk of depression, suicide, reduced quality of life, cardiovascular disease, and health-harming behaviours (11,12). The societal cost of stroke has been estimated at £26 billion per year, including £8.6 billion for health and social care (13).…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial

Radford

KING

McLellan

et al. 2020

Preprint

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Background: Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e., usual NHS rehabilitation) is more clinically and cost effective for supporting post-stroke RTW, than UC alone.Methods: 760 stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants’ homes or workplaces, outpatient/inpatient therapy settings, via telephone, email or SMS text message. Outcome data will be collected via self-report questionnaires administered by post or online at 3, 6, and 12 months follow-up. The primary outcome will be self-reported RTW and job retention at 12 months (minimum 2 hours/week). Secondary outcomes will include: mood; function; participation; health-related quality of life; confidence; intervention compliance; health and social care resource use; and mortality. An embedded economic evaluation will estimate cost-effectiveness and cost-utility analyses from National Health Service (NHS) and Personal Social Services (PSS) perspectives. An embedded process evaluation will employ a mixed methods approach to explore ESSVR implementation, contextual factors linked to outcome variation, and factors affecting NHS roll-out.Discussion: This article describes the protocol for a multi-centre RCT evaluating the clinical- and cost-effectiveness of an early vocational rehabilitation intervention aimed at supporting adults to return to work following a stroke. Evidence favouring the ESSVR intervention would support its roll-out in NHS settings.Trial registration: ISRCTN, ISRCTN12464275.Registered on 26th February 2018, http://www.isrctn.com/ISRCTN12464275.

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“…Conversely, long-term worklessness has been linked to increased risk of depression, suicide, reduced quality of life, cardiovascular disease, and health-harming behaviours [ 11 , 12 ]. The societal cost of stroke has been estimated at £26 billion per year, including £8.6 billion for health and social care [ 13 ]. These costs will likely increase due to strokes occurring at earlier ages, improvements in survival rates, and changes in retirement age provisions [ 1 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial

Radford

Craven

McLellan

et al. 2020

Trials

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Background Return to work (RTW) is achieved by less than 50% of stroke survivors. The rising incidence of stroke among younger people, the UK economic forecast, and clinical drivers highlight the need for stroke survivors to receive support with RTW. However, evidence for this type of support is lacking. This randomised controlled trial (RCT) will investigate whether Early Stroke Specialist Vocational Rehabilitation (ESSVR) plus usual care (UC) (i.e. usual NHS rehabilitation) is more clinically and cost-effective for supporting post-stroke RTW, than UC alone. Methods Seven hundred sixty stroke survivors and their carers will be recruited from approximately 20 NHS stroke services. A 5:4 allocation ratio will be employed to randomise participants to receive ESSVR plus UC, or UC alone. The individually tailored ESSVR intervention will commence within 12 weeks of stroke onset and be delivered for up to 12 months as necessary by trained RETAKE occupational therapists in the community, participants’ homes or workplaces, and outpatient/inpatient therapy settings, via telephone, email, or SMS text message. Outcome data will be collected via self-report questionnaires administered by post or online at 3, 6, and 12 months follow-up. The primary outcome will be self-reported RTW and job retention at 12 months (minimum 2 h/week). Secondary outcomes will include mood, function, participation, health-related quality of life, confidence, intervention compliance, health and social care resource use, and mortality. An embedded economic evaluation will estimate cost-effectiveness and cost-utility analyses from National Health Service (NHS) and Personal Social Services (PSS) perspectives. An embedded process evaluation will employ a mixed methods approach to explore ESSVR implementation, contextual factors linked to outcome variation, and factors affecting NHS roll-out. Discussion This article describes the protocol for a multi-centre RCT evaluating the clinical- and cost-effectiveness of an early vocational rehabilitation intervention aimed at supporting adults to return to work following a stroke. Evidence favouring the ESSVR intervention would support its roll-out in NHS settings. Trial registration ISRCTN, ISRCTN12464275. Registered on 26 February 2018.

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Estimated societal costs of stroke in the UK based on a discrete event simulation

Cited by 96 publications

References 18 publications

Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression

Analysing and quantifying the effect of predictors of stroke direct costs in South Africa using quantile regression

An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial

An individually randomised controlled multi-centre pragmatic trial with embedded economic and process evaluations of early vocational rehabilitation compared with usual care for stroke survivors: study protocol for the RETurn to work After stroKE (RETAKE) trial

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