MS is a costly chronic disease. Further research is needed to understand: costs by MS type, costs associated with increasing disability and early retirement, and the potential impact of new treatments expected to launch in coming years.

Intravenous thrombolysis reduces long-term disability and is cost-effective in acute ischemic stroke (AIS). [1][2][3] Unfortunately, intravenous thrombolysis is underused with rates <5%, 4 attributed in part to a lack of stroke specialists. In rural areas, use of intravenous thrombolysis is further restricted, exacerbated by the dearth of stroke experts and lack of access to endovascular revascularization therapies. 5,6 Hub-and-spoke telestroke networks can overcome these geographic barriers to acute stroke care, enhance stroke diagnosis, increase intravenous thrombolysis administration rates, and improve long-term outcomes. [7][8][9][10][11] In the past decade, telestroke networks have become widespread and represent an expanding model of stroke care, particularly in rural and small hospitals. 12However, telestroke networks are associated with significant upfront costs, and the absence of cost-effectiveness data has hindered further dissemination. Different stakeholders, including government and nongovernment insurers, hospital administrators, and health practitioners, may be interested in the costs and benefits of these establishments to better inform their decisions. A previous study showed that telestroke networks were cost-effective in the long term from a societal perspective. 13 To date, cost-effectiveness of telestroke networks from individual hospitals' perspectives has not been assessed. Such information would be valuable because, to a large extent, decisions on setting up (in the case of a hub hospital) or joining (in the case of a spoke hospital) a telestroke network are made by individual hospitals. Using data from 2 existing telestroke networks, we developed a decision model to assess the costeffectiveness of establishing a hub-and-spoke telestroke referral network from the perspectives of the hub, the spoke, and the network. Our goal was to determine whether the costs and benefits of a telestroke network support its implementation from these 3 key perspectives and to evaluate the sensitivity of these results across a range of plausible variations in model inputs. Methods Model OverviewA decision analytic model (Figure 1) was developed to compare the cost and effectiveness of treating AIS patients with and without a telestroke network from the perspectives of an entire network, a hub hospital, © 2012 American Heart Association, Inc. Background-A hub-and-spoke telestroke network is an effective way to extend quality acute stroke care to remote hospitals and to improve patient outcomes. This study assessed the cost-effectiveness of a telestroke network in the management of acute ischemic stroke from the perspectives of a network, a hub hospital, and a spoke hospital. Methods and Results-A model was developed to compare costs and effectiveness with and without a telestroke network over a 5-year time horizon. The model considered differences in rates of teleconsultations, intravenous thrombolysis, endovascular stroke therapies, and spoke-to-hub transfers. These inputs were estimated through the use of...

Background Understanding the longitudinal course of negative symptoms, especially in relationship to functioning, in the early phase of schizophrenia is crucial to developing intervention approaches. The course of negative symptoms and daily functioning was examined over a one-year period following a recent onset of schizophrenia and at an 8-year follow-up point. Methods The study included 149 recent-onset schizophrenia patients who had a mean age of 23.7 (SD=4.4) years and mean education of 12.9 (SD=2.2) years. Negative symptom (BPRS and SANS) and functional outcome (SCORS) assessments were conducted frequently by trained raters. Results After antipsychotic medication stabilization, negative symptoms during the first outpatient year were moderately stable (BPRS ICC=0.64 and SANS ICC=0.66). Despite this overall moderate stability, 24% of patients experienced at least one period of negative symptoms exacerbation. Furthermore, entry level of negative symptoms was significantly associated with poor social functioning (r =−.34, p < .01) and work/school functioning (r =−.25, p < .05) at 12 months, and with negative symptoms at the 8-year follow-up (r =.29, p <.05). Discussion Early negative symptoms are fairly stable during the first outpatient year, are predictors of daily functioning at 12 months, and predict negative symptoms 8 years later. Despite the high levels of stability, negative symptoms did fluctuate in a subsample of patients. These findings suggest that negative symptoms may be an important early course target for intervention aimed at promoting recovery.

Background The ECASS III study showed that recombinant tissue plasminogen activator (rtPA) given 3–4.5 hours after acute ischemic stroke (AIS) led to improvement in patient disability versus placebo. Objective To evaluate the long-term incremental cost-effectiveness of rtPA given 3–4.5 hours after AIS onset versus no treatment based on patient clinical and demographic factors. Methods We developed a disease-based decision analytic model to project lifetime outcomes of patients post-AIS from the payer perspective. Clinical data were derived from the ECASS III trial, longitudinal cohort studies, and health state preference studies. Cost data were based on Medicare reimbursement and other published sources. We performed probabilistic sensitivity analyses to evaluate uncertainty in the analysis. Results rtPA in a hypothetical cohort of 100 patients resulted in a gain of 7 years of life (95% credible range [CR], 0.05–17) and 24 quality-adjusted life-years (QALYs) (95% CR, 1–60), and a difference in cost of $149,500 (95% CR, −$463,700 – $610,000) compared with placebo. The incremental cost-effectiveness ratio for all patients was $6,300 per QALY gained; for patients <65 years old, cost saving; ≥ 65 years old, $35,800/QALY; for patients with baseline NIHSS 0–9, $16,300/QALY; 10–19, $37,500/QALY; ≥ 20, $2,400/QALY. The majority of other subgroups such as gender, history of stroke, and history of hypertension were cost-saving to cost-effective with the exceptions of diabetes and atrial fibrillation. Conclusion The results indicate that rtPA in the 3- to 4.5-hour therapeutic window provides improvement in long-term patient outcomes in most patient subgroups and is a good economic value versus no treatment.