Carotid Doppler - costs and need after stroke or TIA

Hf, Jespersen; Hs, Jørgensen; Nakayama, Hirofumi; Reith, Jakob; Ts, Olsen

doi:10.1034/j.1600-0404.2002.0o348.x

Cited by 3 publications

(4 citation statements)

References 13 publications

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“…Estimation of actual costs in this study (EUR 207,675–333,918 for preventing 1 recurrent stroke) was considerably higher than previously published cost evaluations [3,4]. However, in these studies much lower values of the NNT were used as the association between NNT and delay from onset of symptoms until CEA was not yet known.…”

Section: Discussioncontrasting

confidence: 42%

“…within 2 weeks of the last ischemic event [5]. Hence, numbers needed to screen relative to the numbers of strokes being prevented by CEA may now be lower, and as a consequence costs per prevented stroke may also be lower than previously estimated [3,4]. …”

Section: Introductionmentioning

confidence: 90%

“…However, when including the costs of identifying patients eligible for CEA and numbers needed to treat (NNT) in order to prevent a stroke, CEA turns out to be a relatively costly way of secondary prevention. In studies from Denmark [3] and the United Kingdom [4], estimated costs to the national health services of these countries of preventing 1 recurrent stroke were EUR 192,000 and 113,910, respectively.…”

Section: Introductionmentioning

confidence: 99%

“…Available estimations of costs are based on patients sampled in 1991/1993 [3] and 1996/1997 [4]. Recent analyses of pooled data from randomized trials published in 2004 show that the NNT in order to prevent a stroke can be substantially reduced if CEA is done early after stroke, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Costs of Secondary Prevention of Stroke by Carotid Endarterectomy

Haedersdal¹,

Søndergaard

Olsen

2012

Eur Neurol

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Background: We estimated the costs to the Danish National Health Service of preventing stroke due to carotid artery stenosis by carotid endarterectomy (CEA), including costs of identifying patients, Doppler ultrasound (DUS) examination and CEA. Methods: Estimations are based on patients with stroke, transient ischemic attacks (TIA) or amaurosis fugax referred for carotid DUS in the municipality of Frederiksberg, Denmark (127,184 residents), within an 18-month period in 2008–2009. Results: In total, 372 patients with stroke (n = 194), TIA (n = 157) or amaurosis fugax (n = 21) were referred for DUS. We identified 12 patients with 50–70% stenosis and 20 patients with >70% stenosis. Six had CEA, all of whom had stenosis >70%. Waiting time from symptom to CEA was a median of 38 days. Costs of preventing 1 recurrent stroke in the study period [number needed to treat (NNT) = 13] was in the range of EUR 207,675–333,918. If CEA had been performed within 2 weeks after onset of symptoms (NNT = 4), costs would be in the range of EUR 63,900–102,744. Conclusion: Costs of preventing stroke by CEA were high. Substantial reductions of costs (by about 2/3) can be achieved if CEA is performed <2 weeks after the ischemic event.

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Section: Discussioncontrasting

confidence: 42%

Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Costs of Secondary Prevention of Stroke by Carotid Endarterectomy

Haedersdal¹,

Søndergaard

Olsen

2012

Eur Neurol

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In-hospital direct cost of acute ischemic and hemorrhagic stroke in Greece

Gioldasis

Talelli

Chroni

et al. 2008

Acta Neurologica Scandinavica

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Long term motor complications of levodopa: clinical features, mechanisms, and management strategies

Thanvi

Lo²

2004

Postgraduate Medical Journal

158

110

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Levodopa is the most effective symptomatic treatment of Parkinson’s disease. However, after an initial period of dramatic benefit, several limitations become apparent including, “dopa resistant” motor symptoms (postural abnormalities, freezing episodes, speech impairment), “dopa resistant” non-motor signs (autonomic dysfunction, mood and cognitive impairment, etc), and/or drug related side effects (especially psychosis, motor fluctuations, and dyskinesias). Motor complications include fluctuations, dyskinesias, and dystonias. They can be very disabling and difficult to treat. Therefore, strategies should ideally be developed to prevent them. Though mechanisms underlying motor complications are only partially understood, recent work has revealed the importance of pulsatile stimulation of postsynaptic dopamine receptors and the disease severity. As a result of intermittent stimulation there occurs a cascade of changes in cell signalling leading to upregulation of the N-methyl-D-aspartate subtype of gamma-aminobutryric acid-ergic neurones. Modified preparations of levodopa (controlled release preparations, liquid levodopa), catecholamine-o-methyltransferase inhibitors, dopamine agonists, amantidine, and various neurosurgical approaches have been used in the prevention and/or treatment of motor complications. Current management of motor complications is less than satisfactory. With better understanding of the pathogenetic mechanisms, it is hoped that future therapeutic strategies will provide a safer and targeted treatment.

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Carotid Doppler - costs and need after stroke or TIA

Abstract: Carotid endarterectomy is expensive due to the large number of patients screened with carotid Doppler per operated patient. A careful clinical selection of patients for screening is necessary.

Cited by 3 publications

References 13 publications

Costs of Secondary Prevention of Stroke by Carotid Endarterectomy

Costs of Secondary Prevention of Stroke by Carotid Endarterectomy

In-hospital direct cost of acute ischemic and hemorrhagic stroke in Greece

Long term motor complications of levodopa: clinical features, mechanisms, and management strategies

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