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Economic burden of stroke: a systematic review on post-stroke care

  • Original Paper
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Abstract

Objectives

Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps.

Methods

A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated.

Results

We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors.

Conclusion

The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.

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Abbreviations

TIA:

Transient ischemic attacks

WHO:

World Health Organization

PPP:

Purchasing power parity

CPI:

Consumer Price Index

CHEERS:

Consolidated Health Economic Evaluation Reporting Standards

SRF:

Skilled nursing facilities

IRF:

Inpatient rehabilitation facilities

ESUS:

Extended stroke unit services

OSUS:

Ordinary stroke unit services

PSC:

Post-stroke care

PM:

Patient month

GDP:

Gross domestic product

AUD:

Australian Dollar

CAD:

Canadian Dollar

DM:

Deutsche Mark

SEK:

Swedish Krona

CHF:

Swiss Franc

£:

UK Pound

$, USD:

US Dollar

References

  1. Land Tirol. (2018). Projekt Integrierter Patientenpfad/Behandlungspfad Schlaganfall Tirol. https://www.schlaganfall-tirol.info https://www.tirol.gv.at/gesundheit-vorsorge/krankenanstalten/schlaganfall/projekt/. Accessed 4 Mar 2017

  2. World Health Organization: Global Health Estimates: Deaths by Cause, Age, Sex and Country, 2000–2012. Geneva, WHO (2014)

    Google Scholar 

  3. Mozaffarian, D., Benjamin, E.J., Go, A.S., Arnett, D.K., Blaha, M.J., Cushman, M., de Ferranti, S., Despres, J.P., Fullerton, H.J., Howard, V.J., Huffman, M.D., Judd, S.E., Kissela, B.M., Lackland, D.T., Lichtman, J.H., Lisabeth, L.D., Liu, S., Mackey, R.H., Matchar, D.B., McGuire, D.K., Mohler, E.R. III, Moy, C.S., Muntner, P., Mussolino, M.E., Nasir, K., Neumar, R.W., Nichol, G., Palaniappan, L., Pandey, D.K., Reeves, M.J., Rodriguez, C.J., Sorlie, P.D., Stein, J., Towfighi, A., Turan, T.N., Virani, S.S., Willey, J.Z., Woo, D., Yeh, R.W., Turner, M.B.: Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation 131(4), e29–e322 (2015). https://doi.org/10.1161/cir.0000000000000152

    Article  PubMed  Google Scholar 

  4. Truelsen, T., Piechowski-Jozwiak, B., Bonita, R., Mathers, C., Bogousslavsky, J., Boysen, G.: Stroke incidence and prevalence in Europe: a review of available data. Eur. J. Neurol. 13(6), 581–598 (2006). https://doi.org/10.1111/j.1468-1331.2006.01138.x

    Article  CAS  PubMed  Google Scholar 

  5. Di Carlo, A.: Human and economic burden of stroke. Age Ageing. 38(1), 4–5 (2009). https://doi.org/10.1093/ageing/afn282

    Article  PubMed  Google Scholar 

  6. Ovbiagele, B., Goldstein, L.B., Higashida, R.T., Howard, V.J., Johnston, S.C., Khavjou, O.A., Lackland, D.T., Lichtman, J.H., Mohl, S., Sacco, R.L., Saver, J.L., Trogdon, J.G.: Forecasting the future of stroke in the United States: a policy statement from the American Heart Association and American Stroke Association. Stroke J. Cereb. Circ. 44(8), 2361–2375 (2013). https://doi.org/10.1161/STR.0b013e31829734f2

    Article  Google Scholar 

  7. Stroke.org. (2018). Rehabilitation Therapy after a Stroke. http://www.stroke.org/we-can-help/stroke-survivors/just-experienced-stroke/rehab. Accessed 8 Feb 2018

  8. Brady, B.K., McGahan, L., Skidmore, B.: Systematic review of economic evidence on stroke rehabilitation services. Int. J. Technol. Assess. Health Care 21(1), 15–21 (2005)

    Article  PubMed  Google Scholar 

  9. Anderson, C., Ni Mhurchu, C., Brown, P.M., Carter, K.: Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: an overview and cost analysis. Pharmacoeconomics 20(8), 537–552 (2002)

    Article  PubMed  Google Scholar 

  10. Larsen, T., Olsen, T.S., Sorensen, J.: Early home-supported discharge of stroke patients: a health technology assessment. Int. J. Technol. Assess. Health Care 22(3), 313–320 (2006)

    Article  PubMed  Google Scholar 

  11. Tummers, J.F., Schrijvers, A.J., Visser-Meily, J.M.: Economic evidence on integrated care for stroke patients; a systematic review. Int. J. Integr. Care 12, e193 (2012)

    Article  PubMed  PubMed Central  Google Scholar 

  12. Polder, J.J.: Cost of illness in the Netherlands: description, comparison and projection. Thesis, Erasmus University Rotterdam (2001)

  13. Harrington, R., Taylor, G., Hollinghurst, S., Reed, M., Kay, H., Wood, V.A.: A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation. Clin. Rehabilit. 24(1), 3–15 (2010). https://doi.org/10.1177/0269215509347437

    Article  Google Scholar 

  14. Humphreys, I., Thomas, S., Phillips, C., Lincoln, N.: Cost analysis of the communication and low mood (CALM) randomised trial of behavioural therapy for stroke patients with aphasia. Clin. Rehabilit. 29(1), 30–41 (2015). https://doi.org/10.1177/0269215514537656

    Article  Google Scholar 

  15. Patel, A., Knapp, M., Evans, A., Perez, I., Kalra, L.: Training care givers of stroke patients: economic evaluation. BMJ. 328(7448), 1102 (2004). https://doi.org/10.1136/bmj.328.7448.1102

    Article  PubMed  PubMed Central  Google Scholar 

  16. Drummond, M.F., Sculpher, M.J., Torrance, G.W., O’Brien, B., Stoddart, G.L.,: Methods for the Economic Evaluation of Health Care Programmes, 3rd edn. Oxford University Press, Oxford (2005)

    Google Scholar 

  17. Wang, G., Zhang, Z., Ayala, C., Dunet, D.O., Fang, J., George, M.G.: Costs of hospitalization for stroke patients aged 18–64 years in the United States. J. Stroke Cerebrovasc. Dis. 23(5), 861–868 (2014). https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.07.017

    Article  PubMed  Google Scholar 

  18. U.S. Department of Labor, Bureau of Labor Statistics, Consumer Price Index. All Urban Consumers (CPI-U). http://www.bls.gov/cpi/ (2015). Accessed 18 Dec 2015

  19. World Bank. Data: GDP per capita. http://data.worldbank.org/indicator/NY.GDP.PCAP.CD (2016). Accessed 8 Aug 2016

  20. OECD (2018) Hospital beds (indicator). https://doi.org/10.1787/0191328e-en

  21. Drummond, M.F., Jefferson, T.O.: Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ economic evaluation working party. BMJ 313(7052), 275–283 (1996)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Husereau, D., Drummond, M., Petrou, S., Carswell, C., Moher, D., Greenberg, D., Augustovski, F., Briggs, A.H., Mauskopf, J., Loder, E.: Consolidated Health Economic Evaluation Reporting Standards (CHEERS) statement. BMC Med. 11(1), 1–6 (2013). https://doi.org/10.1186/1741-7015-11-80

    Article  Google Scholar 

  23. Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G.: Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 6(7), e1000097 (2009). https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  24. Akhavan Hejazi, S.M., Mazlan, M., Abdullah, S.J., Engkasan, J.P.: Cost of post-stroke outpatient care in Malaysia. Singap. Med. J. 56(2), 116–119 (2015)

    Article  Google Scholar 

  25. Gold M.R., Siegel J.E., Russell L.B., Weinstein M.C.: Estimating costs in cost-effectiveness analysis. In: Cost-effectiveness in health and medicine, pp. 176–213. Oxford University Press, New York (1996)

  26. Beeuwkes-Buntin, M.B., Colla, C.H., Deb, P., Sood, N., Escarce, J.J.: Medicare spending and outcomes after postacute care for stroke and hip fracture. Med. Care 48(9), 776–784 (2010). https://doi.org/10.1097/MLR.0b013e3181e359df

    Article  Google Scholar 

  27. Bjorkdahl, A., Sunnerhagen, K.S.: Process skill rather than motor skill seems to be a predictor of costs for rehabilitation after a stroke in working age; a longitudinal study with a 1 year follow up post discharge. BMC Health Serv. Res. 7, 209 (2007). https://doi.org/10.1186/1472-6963-7-209

    Article  PubMed  PubMed Central  Google Scholar 

  28. Hayes, J., Vogel, B., Reker, D.M.: Factors associated with VHA costs of care for first 12 months after first stroke. J. Rehabilit. Res. Dev. 45(9), 1375–1384 (2008)

    Article  Google Scholar 

  29. Kalra, L., Evans, A., Perez, I., Knapp, M., Swift, C., Donaldson, N.: A randomised controlled comparison of alternative strategies in stroke care. Health Technol. Assess. (Winchester, England) 9(18), iii–iv (2005) (1–79)

    CAS  Google Scholar 

  30. Tay-Teo, K., Moodie, M., Bernhardt, J., Thrift, A.G., Collier, J., Donnan, G., Dewey, H.: Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT). Cerebrovasc. Dis. (Basel, Switzerland). 26(5), 475–481 (2008). https://doi.org/10.1159/000155984

    Article  CAS  Google Scholar 

  31. Forster, A., Young, J., Green, J., Patterson, C., Wanklyn, P., Smith, J., Murray, J., Wild, H., Bogle, S., Lowson, K.: Structured re-assessment system at 6 months after a disabling stroke: a randomised controlled trial with resource use and cost study. Age Ageing 38(5), 576–583 (2009). https://doi.org/10.1093/ageing/afp095

    Article  PubMed  Google Scholar 

  32. Simpson, A.N., Bonilha, H.S., Kazley, A.S., Zoller, J.S., Simpson, K.N., Ellis, C.: Impact of outpatient rehabilitation medicare reimbursement caps on utilization and cost of rehabilitation care after ischemic stroke: do caps contain costs? Arch. Phys. Med. Rehabilit. (2015). https://doi.org/10.1016/j.apmr.2015.07.008

    Article  Google Scholar 

  33. Van Exel, J., Koopmanschap, M.A., Van Wijngaarden, J.D., Scholte Op Reimer, W.J.: Costs of stroke and stroke services: determinants of patient costs and a comparison of costs of regular care and care organised in stroke services. Cost Effect. Resour. Alloc. C/E 1(1), 2 (2003)

    Article  Google Scholar 

  34. Godwin, K.M., Wasserman, J., Ostwald, S.K.: Cost associated with stroke: outpatient rehabilitative services and medication. Top. Stroke Rehabilit. 18 Suppl 1, 676–684 (2011). https://doi.org/10.1310/tsr18s01-676

    Article  Google Scholar 

  35. Mahler, M.P., Zuger, K., Kaspar, K., Haefeli, A., Jenni, W., Leniger, T., Beer, J.H.: A cost analysis of the first year after stroke - early triage and inpatient rehabilitation may reduce long term costs. Swiss Med. Wkly. 138(31–32), 459–465 (2008)

    PubMed  Google Scholar 

  36. Liberati, A., Altman, D.G., Tetzlaff, J., Mulrow, C., Gøtzsche, P.C., Ioannidis, J.P.A., Clarke, M., Devereaux, P.J., Kleijnen, J., Moher, D.: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann. Intern. Med. 151(4), W-65 (2009). https://doi.org/10.7326/0003-4819-151-4-200908180-00136

    Article  Google Scholar 

  37. Demaerschalk, B.M., Hwang, H.M., Leung, G.: US cost burden of ischemic stroke: a systematic literature review. Am. J. Manag. Care 16(7), 525–533 (2010)

    PubMed  Google Scholar 

  38. Ekman, M.: Economic evidence in stroke: a review. Eur. J. Health Econ. HEPAC Health Econ. Prev. Care 5(Suppl 1), 74–83 (2004). https://doi.org/10.1007/s10198-005-0292-3

    Article  Google Scholar 

  39. Grieve, R., Hutton, J., Bhalla, A., Rastenyte, D., Ryglewicz, D., Sarti, C., Lamassa, M., Giroud, M., Dundas, R., Wolfe, C.D.: A comparison of the costs and survival of hospital-admitted stroke patients across Europe. Stroke J. Cereb. Circ. 32(7), 1684–1691 (2001)

    Article  CAS  Google Scholar 

  40. Everink, I.H.J., van Haastregt, J.C.M., van Hoof, S.J.M., Schols, J.M.G.A., Kempen, G.I.J.M.: Factors influencing home discharge after inpatient rehabilitation of older patients: a systematic review. BMC Geriatr. 16(1), 1–14 (2016). https://doi.org/10.1186/s12877-016-0187-4

    Article  Google Scholar 

  41. Meijer, R., Ihnenfeldt, D.S., van Limbeek, J., Vermeulen, M., de Haan, R.J.: Prognostic factors in the subacute phase after stroke for the future residence after six months to one year. A systematic review of the literature. Clin. Rehabilit. 17(5), 512–520 (2003)

    Article  CAS  Google Scholar 

  42. Brinjikji, W., Rabinstein, A.A., Cloft, H.J.: Hospitalization costs for acute ischemic stroke patients treated with intravenous thrombolysis in the United States are substantially higher than medicare payments. Stroke J. Cereb. Circ. 43(4), 1131–1133 (2012). https://doi.org/10.1161/strokeaha.111.636142

    Article  Google Scholar 

  43. Claesson, L., Gosman-Hedstrom, G., Johannesson, M., Fagerberg, B., Blomstrand, C.: Resource utilization and costs of stroke unit care integrated in a care continuum: a 1-year controlled, prospective, randomized study in elderly patients: the Goteborg 70 + stroke study. Stroke J. Cereb. Circ. 31(11), 2569–2577 (2000)

    Article  CAS  Google Scholar 

  44. Jain, M., Jain, A., Jahromi, B.S.: Strategies to improve cost-efficiency of stroke care: Stroke units and telestroke. In: Robinson, J.S., Walid, M.S., Barth, A.C.M. (eds.) Toward Healthcare Resource Stewardship. Hauppauge, New York: Nova Publishers (2012)

  45. Saka, O., Serra, V., Samyshkin, Y., McGuire, A., Wolfe, C.C.: Cost-effectiveness of stroke unit care followed by early supported discharge. Stroke J. Cereb. Circ. 40(1), 24–29 (2009). https://doi.org/10.1161/strokeaha.108.518043

    Article  Google Scholar 

  46. Te Ao, B.J., Brown, P.M., Feigin, V.L., Anderson, C.S.: Are stroke units cost effective? Evidence from a New Zealand stroke incidence and population-based study. Int. J. Stroke 7(8), 623–630 (2012). https://doi.org/10.1111/j.1747-4949.2011.00632.x

    Article  PubMed  Google Scholar 

  47. Miller, P., Gladman, J.R., Cunliffe, A.L., Husbands, S.L., Dewey, M.E., Harwood, R.H.: Economic analysis of an early discharge rehabilitation service for older people. Age and ageing (2005). https://doi.org/10.1093/ageing/afi058

    Article  PubMed  Google Scholar 

  48. Saka, R.O., McGuire, A., Wolfe, C.D.A.: Economic Burden of Stroke in England. University of London. https://www.nao.org.uk/wp-content/uploads/2005/11/0506452_economic_analysis.pdf (2003). Accessed 8 Aug 2016

  49. Ghatnekar, O., Persson, U., Glader, E.L., Terent, A.: Cost of stroke in Sweden: an incidence estimate. Int. J. Technol. Assess. Health Care 20(3), 375–380 (2004)

    Article  PubMed  Google Scholar 

  50. Ghatnekar, O., Persson, U., Asplund, K., Glader, E.L.: Costs for stroke in Sweden 2009 and developments since 1997. Int. J. Technol. Assess. Health Care 30(2), 203–209 (2014). https://doi.org/10.1017/s0266462314000075

    Article  PubMed  Google Scholar 

  51. Kolominsky-Rabas, P.L., Heuschmann, P.U., Marschall, D., Emmert, M., Baltzer, N., Neundorfer, B., Schoffski, O., Krobot, K.J.: Lifetime cost of ischemic stroke in Germany: results and national projections from a population-based stroke registry: the Erlangen Stroke Project. Stroke J. Cereb. Circ. 37(5), 1179–1183 (2006). https://doi.org/10.1161/01.str.0000217450.21310.90

    Article  Google Scholar 

  52. Gloede, T.D., Halbach, S.M., Thrift, A.G., Dewey, H.M., Pfaff, H., Cadilhac, D.A.: Long-term costs of stroke using 10-year longitudinal data from the North East Melbourne Stroke Incidence Study. Stroke J. Cereb. Circ. 45(11), 3389–3394 (2014). https://doi.org/10.1161/strokeaha.114.006200

    Article  Google Scholar 

  53. Spieler, J.F., De Pouvourville, G., Amarenco, P.: Cost of a recurrent vs. cost of first-ever stroke over an 18-month period. Eur. J. Neurol. 10(6), 621–624 (2003)

    Article  PubMed  Google Scholar 

  54. Christensen, M.C., Morris, S.: Association between disability measures and short-term health care costs following intracerebral hemorrhage. Neurocrit. Care 9(3), 313–318 (2008). https://doi.org/10.1007/s12028-008-9124-5

    Article  PubMed  Google Scholar 

  55. Alonso-Freyre, J.L., Basanta, L., Vasquez-Roque, A., Vera-Miyar, C.R., Santos-Monzon, Y., Lopez-Hernandez, L.: Degree of independence and cost of ischaemic stroke. Revista de neurologia 32(9), 897–899 (2001)

    Article  CAS  PubMed  Google Scholar 

  56. Fearon, W.F., Shilane, D., Pijls, N.H., Boothroyd, D.B., Tonino, P.A., Barbato, E., Juni, P., De Bruyne, B., Hlatky, M.A.: Cost-effectiveness of percutaneous coronary intervention in patients with stable coronary artery disease and abnormal fractional flow reserve. Circulation. 128(12), 1335–1340 (2013). https://doi.org/10.1161/circulationaha.113.003059

    Article  PubMed  Google Scholar 

  57. Schreyer, P., Koechlin, F.: Purchasing Power Parities—Measurement and Uses. OECD Statistics Brief, No. 3, March. OECD, Paris (2002)

    Google Scholar 

  58. Swart, E.: Health care utilization research using secondary data. In: Janssen, C., Swart, E., von Lengerke, T. (eds.) Health Care Utilization in Germany: Theory, Methodology, and Results, pp. 63–86. Springer, New York (2014)

    Chapter  Google Scholar 

  59. Swart, E., Ihle, P., Gothe, H., Matusiewicz, D.: Routinedaten im Gesundheitswesen. Handbuch Sekundärdatenanalyse: Grundlagen, Methoden und Perspektiven. 2. vollständig überarb. Aufl. Hans Huber, Bern (2014)

    Google Scholar 

  60. Siebert, U.: When should decision-analytic modeling be used in the economic evaluation of health care? Eur. J. Health Econ. 4(3), 143–150 (2003). https://doi.org/10.1007/s10198-003-0205-2

    Article  Google Scholar 

  61. Siebert, U., Rochau, U., Claxton, K.: When is enough evidence enough? Using systematic decision analysis and value-of-information analysis to determine the need for further evidence. Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen. 107(9–10), 575–584 (2013). https://doi.org/10.1016/j.zefq.2013.10.020

    Article  PubMed  Google Scholar 

  62. Anderson, C., Rubenach, S., Mhurchu, C.N., Clark, M., Spencer, C., Winsor, A.: Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: I: health outcomes at 6 months. Stroke J. Cereb. Circ. 31(5), 1024–1031 (2000)

    Article  CAS  Google Scholar 

  63. Cadilhac, D.A., Carter, R., Thrift, A.G., Dewey, H.M.: Estimating the long-term costs of ischemic and hemorrhagic stroke for Australia: new evidence derived from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke J. Cereb. Circ. 40(3), 915–921 (2009). https://doi.org/10.1161/strokeaha.108.526905

    Article  Google Scholar 

  64. Dewey, H.M., Thrift, A.G., Mihalopoulos, C., Carter, R., Macdonell, R.A., McNeil, J.J., Donnan, G.A.: Cost of stroke in Australia from a societal perspective: results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke J. Cereb. Circ. 32(10), 2409–2416 (2001)

    Article  CAS  Google Scholar 

  65. Dewey, H.M., Thrift, A.G., Mihalopoulos, C., Carter, R., Macdonell, R.A., McNeil, J.J., Donnan, G.A.: Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke J. Cereb. Circ. 34(10), 2502–2507 (2003). https://doi.org/10.1161/01.str.0000091395.85357.09

    Article  Google Scholar 

  66. Spieler, J.F., Lanoe, J.L., Amarenco, P.: Costs of stroke care according to handicap levels and stroke subtypes. Cerebrovasc. Dis. (Basel, Switzerland). 17(2–3), 134–142 (2004). https://doi.org/10.1159/000075782

    Article  Google Scholar 

  67. Abbas, S., Ihle, P., Hein, R., Schubert, I.: Rehabilitation in geriatric patients after ischemic stroke—a comparison of 2 organisational systems in Germany using claims data of a statutory health insurance fund. Die Rehabil. 52(6), 375–382 (2013). https://doi.org/10.1055/s-0033-1334914

    Article  CAS  Google Scholar 

  68. Weimar, C., Lüngen, M., Wagner, M., Kraywinkel, K., Evers, T., Busse, O., Haberl, R.L., Laaser, U., Lauterbach, K.W., Diener, H.C.: Cost of stroke care in Germany—an analysis of the stroke data bank of the German foundation stroke-aid. Aktuelle Neurol. 29(4), 181–190 (2002). https://doi.org/10.1055/s-2002-30690

    Article  Google Scholar 

  69. Weimar, C., Weber, C., Wagner, M., Busse, O., Haberl, R.L., Lauterbach, K.W., Diener, H.C.: Management patterns and health care use after intracerebral hemorrhage. A cost-of-illness study from a societal perspective in Germany. Cerebrovasc. Dis. (Basel, Switzerland). 15(1–2), 29–36 (2003)

    Article  Google Scholar 

  70. Fattore, G., Torbica, A., Susi, A., Giovanni, A., Benelli, G., Gozzo, M., Toso, V.: The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 12, 137 (2012). https://doi.org/10.1186/1471-2377-12-137

    Article  PubMed  PubMed Central  Google Scholar 

  71. Gerzeli, S., Tarricone, R., Zolo, P., Colangelo, I., Busca, M.R., Gandolfo, C.: The economic burden of stroke in Italy. The EcLIPSE Study: Economic Longitudinal Incidence-based Project for Stroke Evaluation. Neurol. Sci. 26(2), 72–80 (2005). https://doi.org/10.1007/s10072-005-0439-0

    Article  CAS  PubMed  Google Scholar 

  72. Torbica, A., Calciolari, S., Fattore, G.: Does informal care impact utilization of healthcare services? Evidence from a longitudinal study of stroke patients. Soc. Sci. Med. 1982(124), 29–38 (2015). https://doi.org/10.1016/j.socscimed.2014.11.005

    Article  Google Scholar 

  73. van Eeden, M., van Heugten, C., van Mastrigt, G.A., van Mierlo, M., Visser-Meily, J.M., Evers, S.M.: The burden of stroke in the Netherlands: estimating quality of life and costs for 1 year poststroke. BMJ Open. 5(11), e008220 (2015). https://doi.org/10.1136/bmjopen-2015-008220

    Article  PubMed  PubMed Central  Google Scholar 

  74. Andersson, A., Levin, L.A., Oberg, B., Mansson, L.: Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke. Scand. J. Caring Sci. 16(4), 386–392 (2002)

    Article  PubMed  Google Scholar 

  75. Claesson, L., Linden, T., Skoog, I., Blomstrand, C.: Cognitive impairment after stroke—impact on activities of daily living and costs of care for elderly people. The Goteborg 70+ Stroke Study. Cerebrovasc. Dis. (Basel, Switzerland). 19(2), 102–109 (2005). https://doi.org/10.1159/000082787

    Article  Google Scholar 

  76. von Koch, L., de Pedro-Cuesta, J., Kostulas, V., Almazan, J., Widen Holmqvist, L.: Randomized controlled trial of rehabilitation at home after stroke: one-year follow-up of patient outcome, resource use and cost. Cerebrovasc. Dis. (Basel, Switzerland). 12(2), 131–138 (2001)

    Article  Google Scholar 

  77. Roderick, P., Low, J., Day, R., Peasgood, T., Mullee, M.A., Turnbull, J.C., Villar, T., Raftery, J.: Stroke rehabilitation after hospital discharge: a randomized trial comparing domiciliary and day-hospital care. Age Ageing. 30(4), 303–310 (2001)

    Article  CAS  PubMed  Google Scholar 

  78. Fjaertoft, H., Indredavik, B., Magnussen, J., Johnsen, R.: Early supported discharge for stroke patients improves clinical outcome. Does it also reduce use of health services and costs? One-year follow-up of a randomized controlled trial. Cerebrovasc. Dis. (Basel, Switzerland). 19(6), 376–383 (2005). https://doi.org/10.1159/000085543

    Article  Google Scholar 

  79. Rasmussen, R.S., Ostergaard, A., Kjaer, P., Skerris, A., Skou, C., Christoffersen, J., Seest, L.S., Poulsen, M.B., Ronholt, F., Overgaard, K.: Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: A randomised controlled trial. Clin. Rehabil. (2015). https://doi.org/10.1177/0269215515575165

    Article  PubMed  Google Scholar 

  80. Teng, J., Mayo, N.E., Latimer, E., Hanley, J.: Wood-Dauphinee S, Cote R, Scott S. Costs and caregiver consequences of early supported discharge for stroke patients. Stroke J. Cereb. Circ. 34(2), 528–536 (2003)

    Article  Google Scholar 

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Funding

This work was supported by the Erasmus-Western Balkans mobility programme (ERAWEB), a project funded by the European Commission. The funding source had no influence on study design, analysis and interpretation of data, in the writing of the manuscript and the decision to submit the manuscript for publication.

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Authors and Affiliations

  1. Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum 1, 6060, Hall in Tirol, Austria

    S. Rajsic, H. Gothe, H. H. Borba, G. Sroczynski & Uwe Siebert

  2. Department of Health Sciences/Public Health, Dresden Medical School “Carl Gustav Carus”, Technical University Dresden, Dresden, Germany

    H. Gothe

  3. Department of Pharmacy, Pharmaceutical Sciences Postgraduate Research Program, Federal University of Paraná, Curitiba, Brazil

    H. H. Borba

  4. Faculty of Philosophy, University of Belgrade, Belgrade, Serbia

    J. Vujicic

  5. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    T. Toell

  6. Department of Health Policy and Management, Center for Health Decision Science, Harvard Chan School of Public Health, Boston, MA, USA

    Uwe Siebert

  7. Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Uwe Siebert

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  1. S. Rajsic
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  2. H. Gothe
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  3. H. H. Borba
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  4. G. Sroczynski
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  5. J. Vujicic
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  6. T. Toell
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  7. Uwe Siebert
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Corresponding author

Correspondence to Uwe Siebert.

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Ethical Committee

This work was approved by the Research Committee for Scientific and Ethical Questions (RCSEQ), University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria (Date: April 26, 2016; reference number: 1697).

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Appendices

Appendix 1: Evidence tables

See Tables 2 and 3.

Table 2 Extracted data from observed studies and authors calculations based on observations; for studies with inpatient and outpatient care setting
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Table 3 Extracted data from observed studies and authors calculations based on observations; for studies with outpatient-only care setting
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Appendix 2

See Table 4.

Table 4 Countries oriented mean and weighted average cost of post-stroke care, in USD
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Appendix 3

See Tables 5 and 6.

Table 5 Assessment of methodological quality of included studies (N = 42) using the Drummond checklist [17]
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Table 6 Assessment of reporting quality of included studies using the CHEERS checklist [18]
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Rajsic, S., Gothe, H., Borba, H.H. et al. Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ 20, 107–134 (2019). https://doi.org/10.1007/s10198-018-0984-0

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