Overview of costs of stroke from published, incidence-based studies spanning 16 industrialized countries

Palmer, Andrew J.; Valentine, William J.; Roze, S; Lammert, Morten; Spiesser, J; Gabriel, Sylvie

doi:10.1185/030079904x17992

Cited by 54 publications

(37 citation statements)

References 22 publications

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“…Globally the burden of stroke is greater still (3). The resultant costs are substantial, with stroke care estimated to cost more than 5% of many countries' healthcare budgets (4).…”

Section: Introductionmentioning

confidence: 99%

Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008

et al. 2009

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Objective: Despite recent high-profile advances in our understanding of rehabilitation post-stroke, the evidence base remains weaker than in other areas of stroke management. Under the aegis of the European Stroke Organisation a select committee was assembled to collate and appraise the evidence base for rehabilitation interventions. Methods: Following systematic literature searching, relevant abstracts were screened for data quality and relevance. These data were summarized and presented to the members of the expert panel, who, both individually and across group discussions, modified the content. The process was repeated until a final document was produced that all members of the panel and the European Stroke Organisation editorial group were happy with. Results: The final guidelines offer a comprehensive review of post-stroke rehabilitation, incorporating discussion of optimal timing, setting and duration of therapy as well as individual sections on the role of professions allied to medicine; use of assistive technologies and dealing with the common complications encountered during the rehabilitation period. Conclusion: There is a lack of robust evidence for many of the prevalent post-stroke rehabilitation interventions. Available data are discussed and presented as key points; more importantly, specific areas that require further study are also highlighted.

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“…Globally the burden of stroke is greater still (3). The resultant costs are substantial, with stroke care estimated to cost more than 5% of many countries' healthcare budgets (4).…”

Section: Introductionmentioning

confidence: 99%

Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008

et al. 2009

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“…1 In the United States alone, approximately US $30 to 40 billion is spent annually on stroke management, 2 over half of that incurred for inpatient care. 3 Although the cost-effectiveness of the various stroke treatment modalities is well documented, 4 -6 there is no published literature on physician case volumes as related to cost.…”

mentioning

confidence: 99%

Association Between Physician Volume and Hospitalization Costs for Patients With Stroke in Taiwan

Lin

Xirasagar

Chen

et al. 2007

Stroke

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Background and Purpose-Past studies consistently show an inverse relationship between physicians' surgical procedures/ diagnoses volume and cost. There is little information available on this aspect of stroke care. We used nationwide population-based data to explore the association between physician case volume and costs per discharge for patients with stroke. Methods-Data on all 83 748 hospitalizations for stroke in 2004, treated by 3757 physicians in Taiwan, from Taiwan's National Health Insurance Research Database, was analyzed using hierarchical linear regression modeling to explore associations between costs per discharge and physician case volume (one to 44 casesϭlow volume, 44 to 135ϭmedium volume, Ն136 casesϭhigh volume) adjusting for patient's age, gender, comorbidities, and stroke type; hospital ownership, teaching status, and geographic region; and physician demographics. Results-Unadjusted mean cost per discharge was highest for patients treated by low-volume physicians, at NT $79 993 compared with NT $78 588 for medium-volume physicians and NT $43 942 for high-volume physicians (PϽ0.001).Adjusted for patient, hospital, and physician variables, low-volume physicians had a mean case cost of NT $27 729 higher than high-volume physicians (Pϭ0.001) and NT $7761 higher than medium-volume physicians (Pϭ0.027). Conclusions-Our data confirm an inverse volume-cost relationship for stroke care in Taiwan. After adjusting for patient, hospital, and physician characteristics, the potential cost savings if all patients were treated or supervised by high-volume physicians could be 41.0% of the mean treatment cost incurred by low-volume physicians.

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“…It is also a major cause of permanent disability and stroke management is associated with a vast economic burden 4 . Due to an increase in the proportion of elderly people and the future effects of smoking patterns in less developed countries, stroke mortality is estimated to double by the year 2020 1 .…”

Section: Background Brain Ischemiamentioning

confidence: 99%

Efficient non-viral transfection of adult neural stem/progenitor cells, without affecting viability, proliferation or differentiation

2005

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Stroke is one of the leading causes of chronic disability and death in the Western world. Today, no treatment can repair the cellular loss associated with an ischemic lesion. However, the discovery and dynamic regulation of neural stem/progenitor cells in the adult mammalian brain has resulted in exciting possibilities for future therapeutic interventions. Endogenous or grafted neural stem/progenitor cells are activated following an ischemic insult. These cells undergo directed migration towards infarcted areas, and differentiate in response to the insult. Unfortunately, the results of this regenerative effort are limited compared to the amount of tissue loss. This could be due to low survival of the recruited cells, but could also be explained by insufficient activation or dysfunctional lineage selection. Whether the lineage selection of neural stem/progenitor cells is altered following a lesion in the brain, what signals that are responsible for their activation or whether these cells can participate in post-lesion regeneration, astrogliosis or neuroprotection have yet to become clear. A greater understanding of these processes is necessary for finding ways to improve the endogenous regenerative capacity. We found that reactive astrocytes, a prominent part of the post-ischemic environment, induced astroglial differentiation of adult neural stem/progenitor cells in vitro. Moreover, astrocytes derived from these cells were shown to participate in glial scar formation in vitro. After studying gene expression in the peri-infarct region following focal ischemia, the expression of several genes was induced. We chose to focus our attention on one of these genes and its product, thyrotropin-releasing hormone (TRH). Immunoreactivity for TRH was found in several areas in both lesioned and intact brain regions, including in microglia present in the areas surrounding the lesion. Furthermore, TRH receptors were expressed on cultured neural stem/progenitor cells and TRH potently induced the proliferation of these cells. TRH is an interesting target for stroke treatment, but it also has many central effects in the brain and systemic administration may prove problematic. An interesting protocol for local delivery of TRH would be by grafting stem/progenitor cells, genetically engineered to secrete the peptide. In order to create a foundation for neuroprotective gene therapy, we developed efficient methods for non-viral transfection of neural stem/progenitor cells. Since neural stem/progenitor cells migrate towards the ischemic area we wanted to investigate whether these cells secreted factors that could protect neurons against excitotoxicity, the main inducer of cell death following a stroke. Mass spectrometric analysis of factors secreted from cultured neural stem/progenitor cells led to the identification of a novel neuroprotective peptide, which we termed pentinin. This peptide potently reduced excitotoxicity in both mature and immature neurons in an ex vivo hippocampal slice model. The results presented in this the...

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Overview of costs of stroke from published, incidence-based studies spanning 16 industrialized countries

Abstract: Conducting research according to methodological consensus would markedly improve the quality of data from future studies of stroke and support identification of the main cost drivers in different country-specific settings.

Cited by 54 publications

References 22 publications

Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008

Evidence-based stroke rehabilitation: an expanded guidance document from the european stroke organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008

Association Between Physician Volume and Hospitalization Costs for Patients With Stroke in Taiwan

Efficient non-viral transfection of adult neural stem/progenitor cells, without affecting viability, proliferation or differentiation

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