Projected costs of ischemic stroke in the United States

Brown, Devin L.; Boden‐Albala, Bernadette; Langa, Kenneth M.; Lisabeth, Lynda D.; Fair, Molly; Smith, Melinda A.; Sacco, Ralph L.; Morgenstern, Lewis B.

doi:10.1212/01.wnl.0000237024.16438.20

Cited by 193 publications

(116 citation statements)

References 31 publications

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“…4 Poststroke rehabilitation or postacute care (PAC) is associated with improved functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…3 Largely due to lost wages and institutionalization, working age stroke patients account for around half of the estimated $2.2 trillion in US stroke-related cumulative expenditures projected over the next 4 decades. 4 Poststroke rehabilitation or postacute care (PAC) is associated with improved functional outcomes. [5][6][7] PAC services occur in a range of settings, from private residences and outpatient facilities to institutional PAC services which include both inpatient rehabilitation facilities (IRFs) and skilled nursing facilities (SNFs).…”

mentioning

confidence: 99%

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Effect of insurance status on postacute care among working age stroke survivors

Skolarus¹,

Meurer

Burke³

et al. 2012

Neurology

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Objective: Utilization of postacute care is associated with improved poststroke outcomes. However, more than 20% of American adults under age 65 are uninsured. We sought to determine whether insurance status is associated with utilization and intensity of institutional postacute care among working age stroke survivors. Methods:A retrospective cross-sectional study of ischemic stroke survivors under age 65 from the 2004-2006 Nationwide Inpatient Sample was conducted. Hierarchical logistic regression models controlling for patient and hospital-level factors were used. The primary outcome was utilization of any institutional postacute care (inpatient rehabilitation or skilled nursing facilities) following hospital admission for ischemic stroke. Intensity of rehabilitation was explored by comparing utilization of inpatient rehabilitation facilities and skilled nursing facilities. Results:Of the 33,917 working age stroke survivors, 19.3% were uninsured, 19.8% were Medicaid enrollees, and 22.8% were discharged to institutional postacute care. Compared to those privately insured, uninsured stroke survivors were less likely (adjusted odds ratio [AOR] 0.53, 95% confidence interval [CI] 0.47-0.59) while stroke survivors with Medicaid were more likely to utilize any institutional postacute care (AOR ϭ 1.40, 95% CI 1.27-1.54). Among stroke survivors who utilized institutional postacute care, uninsured (AOR ϭ 0.48, 95% CI 0.36-0.64) and Medicaid stroke survivors (AOR ϭ 0.27, 95% CI 0.23-0.33) were less likely to utilize an inpatient rehabilitation facility than a skilled nursing facility compared to privately insured stroke survivors. Stroke is a leading cause of long-term disability. Conclusions:1 An estimated 7 million Americans have had a stroke.2 Approximately 20% of strokes occur among people younger than 65 years (working age).3 Largely due to lost wages and institutionalization, working age stroke patients account for around half of the estimated $2.2 trillion in US stroke-related cumulative expenditures projected over the next 4 decades. 4 Poststroke rehabilitation or postacute care (PAC) is associated with improved functional outcomes.5-7 PAC services occur in a range of settings, from private residences and outpatient facilities to institutional PAC services which include both inpatient rehabilitation facilities

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“…4 Poststroke rehabilitation or postacute care (PAC) is associated with improved functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of insurance status on postacute care among working age stroke survivors

Skolarus¹,

Meurer

Burke³

et al. 2012

Neurology

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“…65 Lifetime costs per stroke patient were estimated at between $59,800 and $230,000. 77 Brown et al 78 …”

Section: Stroke Costsmentioning

confidence: 99%

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

Bashshur

Shannon

Smith

et al. 2014

Telemedicine and e-Health

295

210

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The telemedicine intervention in chronic disease management promises to involve patients in their own care, provides continuous monitoring by their healthcare providers, identifies early symptoms, and responds promptly to exacerbations in their illnesses. This review set out to establish the evidence from the available literature on the impact of telemedicine for the management of three chronic diseases: congestive heart failure, stroke, and chronic obstructive pulmonary disease. By design, the review focuses on a limited set of representative chronic diseases because of their current and increasing importance relative to their prevalence, associated morbidity, mortality, and cost. Furthermore, these three diseases are amenable to timely interventions and secondary prevention through telemonitoring. The preponderance of evidence from studies using rigorous research methods points to beneficial results from telemonitoring in its various manifestations, albeit with a few exceptions. Generally, the benefits include reductions in use of service: hospital admissions/readmissions, length of hospital stay, and emergency department visits typically declined. It is important that there often were reductions in mortality. Few studies reported neutral or mixed findings.

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“…We assumed that 2 nurses and 1 physician from each spoke hospital would need to be trained by 1 nurse and 1 physician from the hub hospital. Patient care costs were obtained from published literature and included tPA 18 and transfer 19,20 costs (which were independent of stroke severity), as well as hospital, 21 rehabilitation, 22 skilled nursing facility, 22 and daily caregiver 23 costs (which varied by mRS score). Transferring patients from one facility to another can be done by ground or by air.…”

Section: Event Probabilitiesmentioning

confidence: 99%

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

et al. 2011

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Objective: To conduct a cost-effectiveness analysis of telestroke-a 2-way, audiovisual technology that links stroke specialists to remote emergency department physicians and their stroke patients-compared to usual care (i.e., remote emergency departments without telestroke consultation or stroke experts). Methods:A decision-analytic model was developed for both 90-day and lifetime horizons. Model inputs were taken from published literature where available and supplemented with western states' telestroke experiences. Costs were gathered using a societal perspective and converted to 2008 US dollars. Quality-adjusted life-years (QALYs) gained were combined with costs to generate incremental cost-effectiveness ratios (ICERs). In the lifetime horizon model, both costs and QALYs were discounted at 3% annually. Both one-way sensitivity analyses and Monte Carlo simulations were performed. Results:In the base case analysis, compared to usual care, telestroke results in an ICER of $108,363/QALY in the 90-day horizon and $2,449/QALY in the lifetime horizon. For the 90-day and lifetime horizons, 37.5% and 99.7% of 10,000 Monte Carlo simulations yielded ICERs Ͻ$50,000/QALY, a ratio commonly considered acceptable in the United States.

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Projected costs of ischemic stroke in the United States

Abstract: The economic burden of stroke in African Americans and Hispanics will be enormous over the next several decades. Further efforts to improve stroke prevention and treatment in these high stroke risk groups are necessary.

Cited by 193 publications

References 31 publications

Effect of insurance status on postacute care among working age stroke survivors

Effect of insurance status on postacute care among working age stroke survivors

The Empirical Foundations of Telemedicine Interventions for Chronic Disease Management

The cost-effectiveness of telestroke in the treatment of acute ischemic stroke

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