Nihilism and stroke therapy.

Biller, José; Love, Betsy B.

doi:10.1161/01.str.22.9.1105

Cited by 39 publications

(15 citation statements)

References 9 publications

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“…Clinicians have approached the specific treatment of strokes from the perspective of primary prevention, stressing control of risk factors [1,2,3]. Treatment of the acute event is generally limited to the maintenance of vital functions and the avoidance of complications [4].…”

Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Thrombolytic Treatment for Stroke

2005

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Purpose: Thrombolysis is used to treat stroke patients based on the National Institute of Neurological Disorders and Stroke study and meta-analysis results. We present a cost-effectiveness analysis based on a probabilistic model of the use of thrombolytic therapy in stroke treatment. Methods: We surveyed patients who had had a stroke during their hospital stay and examined them again 1 year after release from the hospital to obtain data on costs and natural history. We then calculated utility weights using the European Quality of Life Questionnaire. When the model runs, 4,000 Monte Carlo simulations are undertaken in which each parameter value changes depending on its probability distribution. The results are expressed in terms of the cost-effectiveness plane and the cost-effectiveness acceptability curve. Results: We studied 435 patients, of whom 304 had had an ischemic stroke. One year later, 216 were still alive. The mean utility values were 0.22 for disabled patients and 0.77 for autonomous patients. The incremental cost-effectiveness ratio (ICER) obtained by means of the parameters was –19,000 EUR/quality-adjusted life year, reflecting a saving of 6,000 EUR and a health benefit for patients. The cost-effectiveness plane showed that thrombolysis was a dominant variable in 96.1% of simulations. In the acceptability curves, only 0.4 of simulations obtained an ICER higher than the societal threshold. Conclusions: Thrombolytic therapy seems to be a useful intervention because it is inexpensive and cost-effective. The key factor is the decreased rate of disability, which results in a better quality of life of the patient and lower costs.

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Section: Introductionmentioning

confidence: 99%

Cost-Effectiveness Analysis of Thrombolytic Treatment for Stroke

2005

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“…1 In spite of these human and financial costs, stroke unfortunately has not received a great deal of attention, and its management has been marred by an element of nihilism. 2 Caplan 3 concludes that past failures to establish effective therapies for stroke are due to problems in clinical trial design, lack of interest in care of stroke, and lack of available technologies to evaluate patients. However, with advances in diagnosis and treatment, stroke can now be managed as the life-threatening emergency that it is.…”

mentioning

confidence: 99%

Guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the Stroke Council, American Heart Association.

Adams¹,

Brott²,

Crowell³

et al. 1994

Stroke

480

298

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“…Futility has been the traditional emphasis of healthcare professional education regarding stroke management. This nihilistic approach has pervaded our entire societal attitude toward stroke [28]. Even in communities with academic stroke centers, knowledge about stroke is lacking among most community healthcare professionals [25,29].…”

Section: Missionmentioning

confidence: 99%