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

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

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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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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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The authors declare that they have no conflict of interest.

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

Appendix 2

See Table 4.

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

Appendix 3

See Tables 5 and 6.

Table 5 Assessment of methodological quality of included studies (N = 42) using the Drummond checklist [17]
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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  • DOI: https://doi.org/10.1007/s10198-018-0984-0

Keywords

  • Stroke
  • Cerebrovascular accident
  • Post-stroke care
  • Rehabilitation
  • Economic evaluation
  • Cost

JEL Classification

  • I19