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



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.


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.


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.


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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Transient ischemic attacks


World Health Organization


Purchasing power parity


Consumer Price Index


Consolidated Health Economic Evaluation Reporting Standards


Skilled nursing facilities


Inpatient rehabilitation facilities


Extended stroke unit services


Ordinary stroke unit services


Post-stroke care


Patient month


Gross domestic product


Australian Dollar


Canadian Dollar


Deutsche Mark


Swedish Krona


Swiss Franc


UK Pound

$, USD:

US Dollar


  1. Land Tirol. (2018). Projekt Integrierter Patientenpfad/Behandlungspfad Schlaganfall Tirol. 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).

    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).

    CAS  Article  PubMed  Google Scholar 

  5. Di Carlo, A.: Human and economic burden of stroke. Age Ageing. 38(1), 4–5 (2009).

    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).

    Article  Google Scholar 

  7. (2018). Rehabilitation Therapy after a Stroke. 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).

    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).

    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).

    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).

    Article  PubMed  Google Scholar 

  18. U.S. Department of Labor, Bureau of Labor Statistics, Consumer Price Index. All Urban Consumers (CPI-U). (2015). Accessed 18 Dec 2015

  19. World Bank. Data: GDP per capita. (2016). Accessed 8 Aug 2016

  20. OECD (2018) Hospital beds (indicator).

  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)

    CAS  Article  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).

    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).

    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).

    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).

    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).

    CAS  Article  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).

    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).

    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).

    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).

    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).

    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)

    CAS  Article  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).

    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)

    CAS  Article  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).

    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)

    CAS  Article  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).

    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).

    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).

    Article  PubMed  Google Scholar 

  48. Saka, R.O., McGuire, A., Wolfe, C.D.A.: Economic Burden of Stroke in England. University of London. (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).

    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).

    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).

    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).

    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)

    CAS  Article  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).

    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).

    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).

    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)

    CAS  Article  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).

    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)

    CAS  Article  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).

    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).

    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).

    CAS  Article  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).

    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).

    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).

    CAS  Article  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).

    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).

    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).

    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)

    CAS  Article  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).

    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).

    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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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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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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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).

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

JEL Classification

  • I19