Lifetime Cost of Stroke Subtypes in Australia

Dewey, Helen M; Thrift, Amanda G.; Mihalopoulos, Cathrine; Carter, Rob; Macdonell, Richard; McNeil, John J; Donnan, Geoffrey A.

doi:10.1161/01.str.0000091395.85357.09

Cited by 85 publications

(48 citation statements)

References 20 publications

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“…8,17 Our rehabilitation cohort had similarly far more anterior circulation strokes. These were primarily in the MCA distribution.…”

Section: Discussionmentioning

confidence: 90%

“…8 Further research is needed to explore the long-term outcomes of ischemic stroke subtypes and the functional outcomes of recurrent strokes in different territories.…”

Section: Discussionmentioning

confidence: 99%

“…Such an overview is important because it provides epidemiologic data in stroke rehabilitation and prognostication as well as providing guidelines in planning limited rehabilitation resources, discharge disposition, and utilization of healthcare funding. 8 In this study, we categorized stroke by vascular territory because it is practical and commonly used by clinicians and researchers in stroke care, including neurologists and rehabilitation physicians. The main aim of this prospective stroke database review is to provide baseline and comparative demographic, clinical, and functional outcome data of ischemic stroke categorized by different vascular territories.…”

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confidence: 99%

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Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Stein

Ning

et al. 2007

Stroke

214

136

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Background and Purpose-We aim to compare demographics and functional outcomes of patients with stroke in a variety of vascular territories who underwent inpatient rehabilitation. Such comparative data are important in functional prognostication, rehabilitation, and healthcare planning, but literature is scarce and isolated. Methods-Using data collected prospectively over a 9-year period, we studied 2213 individuals who sustained first-ever ischemic strokes and were admitted to an inpatient stroke rehabilitation program. Strokes were divided into anterior cerebral artery, middle cerebral artery (MCA), posterior cerebral artery, brain stem, cerebellar, small-vessel strokes, and strokes occurring in more than one vascular territory. The main functional outcome measure was the Functional Independence Measure (FIM). Repeated-measures analysis of covariance with post hoc analyses was used to compare functional outcomes of the stroke groups. Results-The most common stroke groups were MCA stroke (50.8%) and small-vessel stroke (12.8%). After adjustments for age, gender, risk factors, and admission year, the stroke groups can be arranged from most to least severe disability on admission: strokes in more than one vascular territory, MCA, anterior cerebral artery, posterior cerebral artery, brain stem, cerebellar, and small-vessel strokes. The sequence was similar on discharge, except cerebellar strokes had the least disability rather than small-vessel strokes. Hemispheric (more than one vascular territory, MCA, anterior cerebral artery, posterior cerebral artery) strokes collectively have significantly lower admission and discharge total and cognitive FIM scores compared with the other stroke groups. MCA stroke had the lowest FIM efficiency and cerebellar stroke the highest. Regardless, patients with stroke made significant (PϽ0.001) and approximately equal (Pϭ0.535) functional gains in all groups. Higher admission motor and cognitive FIM scores, longer rehabilitation stay, younger patients, lower number of medical complications, and a year of admission after 2000 were associated with higher discharge total FIM scores on multiple regression analysis. Conclusions-Patients with stroke made significant functional gains and should be offered rehabilitation regardless of stroke vascular territory. The initial functional status at admission, rather than the stroke subgroup, better predicts discharge functional outcomes postrehabilitation.

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“…8,17 Our rehabilitation cohort had similarly far more anterior circulation strokes. These were primarily in the MCA distribution.…”

Section: Discussionmentioning

confidence: 90%

“…8 Further research is needed to explore the long-term outcomes of ischemic stroke subtypes and the functional outcomes of recurrent strokes in different territories.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Stein

Ning

et al. 2007

Stroke

214

136

View full text Add to dashboard Cite

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“…The general view is that population-based studies with full case ascertainment are the most accurate sources of information on disease incidence, mortality, and outcome. 18,19 For example, previous studies have often only included hospitalized patients, who are easier to identify, omitting minor stroke or TIA patients who are managed in the community. 20 Therefore, by focusing on an unselected study sample, inclusion bias will be minimized.…”

Section: Use a Study Sample That Is Representative Of The Overall Popmentioning

confidence: 99%

Costs of Stroke Using Patient-Level Data

Luengo-Fernández

Gray

Rothwell

2009

Stroke

122

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Background and Purpose-With decision-analytic models becoming more popular to assess the cost-effectiveness of health care interventions, the need for robust estimates on the costs of cerebrovascular disease is paramount. This study reports the results from a literature review of the costs of cerebrovascular diseases, and assesses the quality of the published evidence against a set of defined criteria. Methods-A broad literature search was conducted. Those studies reporting mean/median costs of cerebrovascular diseases derived from patient-level data in a developed country setting were included. Data were abstracted using standardized reporting forms and assessed against 4 predefined criteria: use of adequate methodologies, use of a population-based study, inclusion of premorbid resource use, and reporting of costs by different patient subgroups. Results-A total of 120 cost studies were identified. The cost estimates of stroke were compared by taking into account the effects of inflation and price differentials between countries. Average costs of stroke ranged from $468 to $146 149. Differences in costs were also found within country, with estimates in the USA varying 20-fold. Although the costing methodologies used were generally appropriate, only 5 studies were based on population-based studies, which are the gold standard study design when comparing incidence, outcome, and costs. Conclusions-This review showed large variations in the costs of stroke, mainly attributable to differences in the populations studied, methods, and cost categories included. The wide range of cost estimates could lead to selection bias in secondary health economic analyses, with authors including those costs that are more likely to produce the desired results. (Stroke. 2009;40:e18-e23.)

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“…8 However, although the costs associated with acute care have been widely reported, [9][10][11] relatively few studies have evaluated the long-term costs of stroke management. [12][13][14][15][16][17] As stroke is a disease of the elderly, with an increasingly ageing population 18 it is anticipated that the incidence of stroke and associated demands on healthcare costs will rise substantially in the future. However, as healthcare funds are limited, cost-effective stroke prevention strategies are clearly needed.…”

Section: Introductionmentioning

confidence: 99%

Cost-effectiveness of losartan-based therapy in patients with hypertension and left ventricular hypertrophy: a UK-based economic evaluation of the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study

2005

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The Losartan Intervention for Endpoint reduction in hypertension (LIFE) study demonstrated the clinical benefit of losartan-based therapy in hypertensive patients with left ventricular hypertrophy (LVH), mainly due to a highly significant 25% reduction in the relative risk of stroke compared with an atenolol-based regimen, for a similar reduction in blood pressure. The aim of this economic evaluation was to estimate the cost-effectiveness of losartan compared with atenolol from a UK national health system perspective. Quality-adjusted survival and direct medical costs were modelled beyond the trial using the within-trial incidence of stroke. Survival with stroke, study medication use and quality of life by stroke status were taken directly from the LIFE trial. The LIFE data were supplemented with UK data on lifetime direct medical costs of stroke and life expectancy in individuals without stroke. No additional stroke events or use of study treatment were assumed beyond the trial. Costs and benefits were discounted using current UK Treasury rates. In the base-case analysis, the reduction in stroke-related costs (by £968) offset 86% of the increase in study medication costs (£1128) among losartan-treated patients. The incremental cost-effectiveness ratio (ICER) for losartan versus atenolol in hypertensive patients with LVH was £2130 per qualityadjusted life year (QALY) gained ($3195/QALY), and this increased to £11 352 per QALY gained ($16 450/QALY) when the costs of stroke beyond the first 5 years were excluded. Thus, the clinical benefit of losartan was achieved at a cost well within reported thresholds for cost-effectiveness.

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Lifetime Cost of Stroke Subtypes in Australia

Cited by 85 publications

References 20 publications

Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Comparison of Clinical Characteristics and Functional Outcomes of Ischemic Stroke in Different Vascular Territories

Costs of Stroke Using Patient-Level Data

Cost-effectiveness of losartan-based therapy in patients with hypertension and left ventricular hypertrophy: a UK-based economic evaluation of the Losartan Intervention For Endpoint reduction in hypertension (LIFE) study

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