Análise de custo-efetividade da trombólise com alteplase no Acidente Vascular Cerebral

Araújo, Denizar Vianna; Teich, Vanessa; Passos, Roberta Benitez Freitas; Martins, Sheila Cristina Ouriques

doi:10.1590/s0066-782x2010005000067

Cited by 31 publications

(10 citation statements)

References 16 publications

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“…The costs associated with greater stroke severity and disability in eligible IS patients not treated with reperfusion therapies were not calculated. In high-income countries, the cost-effectiveness of cerebral reperfusion for IS has been defined, 27,28 however, in Brazil, only one retrospective study has shown that the use of thrombolysis in IS patients changes the natural history of the disease and, moreover, that the intervention contributes to the reduction of direct (hospitalization and rehabilitation) and indirect (loss of productivity) costs 29 . It is highly likely that thrombectomy is also cost-effective in developing countries.…”

Section: Discussionmentioning

confidence: 99%

The cost of stroke in private hospitals in Brazil: a one-year prospective study

Vieira¹,

Safanelli

Araujo³

et al. 2019

Arq. Neuro-Psiquiatr.

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Few studies from low- and middle-income countries have assessed stroke and cerebral reperfusion costs from the private sector. Objective To measure the in-hospital costs of ischemic stroke (IS), with and without cerebral reperfusion, primary intracerebral hemorrhage (PIH), subarachnoid hemorrhage (SAH) and transient ischemic attacks (TIA) in two private hospitals in Joinville, Brazil. Methods Prospective disease-cost study. All medical and nonmedical costs for patients admitted with any stroke type or TIA were consecutively determined in 2016-17. All costs were adjusted to the gross domestic product deflator index and purchasing power parity. Results We included 173 patients. The median cost per patient was US$3,827 (IQR: 2,800-8,664) for the 131 IS patients; US$2,315 (IQR: 1,692-2,959) for the 27 TIA patients; US$16,442 (IQR: 5,108-33,355) for the 11 PIH patients and US$28,928 (IQR: 12,424-48,037) for the four SAH patients (p < 0.00001). For the six IS patients who underwent intravenous thrombolysis, the median cost per patient was US$11,463 (IQR: 8,931-14,291), and for the four IS patients who underwent intra-arterial thrombectomy, the median cost per patient was US$35,092 (IQR: 31,833-37,626; p < 0.0001). A direct correlation was found between cost and length of stay (r = 0.67, p < 0.001). Conclusions Stroke is a costly disease. In the private sector, the costs of cerebral reperfusion for IS treatment were three-to-ten times higher than for usual treatments. Therefore, cost-effectiveness studies are urgently needed in low- and middle-income countries.

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Section: Discussionmentioning

confidence: 99%

The cost of stroke in private hospitals in Brazil: a one-year prospective study

Vieira¹,

Safanelli

Araujo³

et al. 2019

Arq. Neuro-Psiquiatr.

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“…Con respecto al segundo caso clínico, el uso de rt-PA para fibrinólisis en casos de ACV isqué-micos agudos tiene una efectividad conocida en cuanto a recuperar la independencia del paciente y un margen de seguridad aceptable si se realiza según protocolos establecidos 14,15 . La evolución clínica favorable y la disolución del trombo en este paciente con un tratamiento médico (y no quirúrgico como en el primer caso) demostraron que la decisión de iniciar heparina fue la adecuada.…”

Section: Discussionunclassified

Accidente cerebrovascular isquémico en pacientes con trombo intracavitario: Experiencia con tratamientos distintos en fase aguda

Oberreuter¹,

Silva²,

Caba³

et al. 2014

Rev. méd. Chile

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“…The direct economic costs to the NHS are considerable, accounting for approximately 5% of total UK NHS costs or £4 billion [9]. The burden of stroke can be considerably reduced if patients are rapidly thombolysed following the onset of symptoms by specialists in secondary care [10], as soon as possible after symptom onset [11], and within the 4.5 hours ‘therapeutic window’ [12-14]. Yet only 4-5% of patients with stroke receive thrombolysis in developed countries [15,16].…”

Section: Introductionmentioning

confidence: 99%

Receptionist rECognition and rEferral of PaTients with Stroke (RECEPTS) study - protocol of a mixed methods study

Sheppard

Singh²,

Jones

et al. 2014

BMC Fam Pract

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BackgroundAs the first point of contact for patients and witnesses of stroke, General Practice receptionists can be instrumental in deciding the urgency of clinical contact. Despite the considerable complexity of this task, reception staff are not clinically trained. Minimising the time taken to access thrombolysis is crucial in acute stroke as treatment must be initiated within 4.5 hours of the onset, and the earlier the better, to achieve the best outcomes. Research suggests that patients who first contact their General Practice following the onset of stroke symptoms are less likely to receive thrombolysis, in part due to significant delays within Primary Care.This study therefore aims to understand the role of General Practice receptionists, with particular interest in receptionist’s ability to recognise people who may be suffering from a stroke and to handle such patients as a medical emergency.MethodsThe Receptionist rECognition and rEferral of PaTients with Stroke (RECEPTS) study will be a Primary Care based mixed methods study. 60 General Practices in the West Midlands will be recruited. Each practice will receive 10 unannounced simulated patient telephone calls, after the 10 calls questionnaires will be administered to each receptionist. These will examine the behaviour of receptionists towards patients presenting in Primary Care with stroke symptoms, and their knowledge of stroke symptoms. An embedded qualitative study will use interviews and focus groups to investigate the views of General Practice staff on the receptionists’ role in patient referral and whether training in this area would be helpful.DiscussionThe results of the RECEPTS study will have important implications for providers of Primary Care. The study will establish current practice in UK primary care in terms of General Practice receptionists’ knowledge of the presentation and appropriate referral of those who may be suffering a stroke. It will highlight training needs and how such training might be best delivered.

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Análise de custo-efetividade da trombólise com alteplase no Acidente Vascular Cerebral

Abstract: Background: The cerebrovascular accident (CVA) or stroke is the main cause of death in Brazil and little information is available on the cost of treatment.

Cited by 31 publications

References 16 publications

The cost of stroke in private hospitals in Brazil: a one-year prospective study

The cost of stroke in private hospitals in Brazil: a one-year prospective study

Accidente cerebrovascular isquémico en pacientes con trombo intracavitario: Experiencia con tratamientos distintos en fase aguda

Receptionist rECognition and rEferral of PaTients with Stroke (RECEPTS) study - protocol of a mixed methods study

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