Abstract
Objectives
Stroke is a leading cause for disability and morbidity associated with increased economic burden due to treatment and post-stroke care (PSC). The aim of our study is to provide information on resource consumption for PSC, to identify relevant cost drivers, and to discuss potential information gaps.
Methods
A systematic literature review on economic studies reporting PSC-associated data was performed in PubMed/MEDLINE, Scopus/Elsevier and Cochrane databases, Google Scholar and gray literature ranging from January 2000 to August 2016. Results for post-stroke interventions (treatment and care) were systematically extracted and summarized in evidence tables reporting study characteristics and economic outcomes. Economic results were converted to 2015 US Dollars, and the total cost of PSC per patient month (PM) was calculated.
Results
We included 42 studies. Overall PSC costs (inpatient/outpatient) were highest in the USA ($4850/PM) and lowest in Australia ($752/PM). Studies assessing only outpatient care reported the highest cost in the United Kingdom ($883/PM), and the lowest in Malaysia ($192/PM). Fifteen different segments of specific services utilization were described, in which rehabilitation and nursing care were identified as the major contributors.
Conclusion
The highest PSC costs were observed in the USA, with rehabilitation services being the main cost driver. Due to diversity in reporting, it was not possible to conduct a detailed cost analysis addressing different segments of services. Further approaches should benefit from the advantages of administrative and claims data, focusing on inpatient/outpatient PSC cost and its predictors, assuring appropriate resource allocation.
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Abbreviations
- TIA:
-
Transient ischemic attacks
- WHO:
-
World Health Organization
- PPP:
-
Purchasing power parity
- CPI:
-
Consumer Price Index
- CHEERS:
-
Consolidated Health Economic Evaluation Reporting Standards
- SRF:
-
Skilled nursing facilities
- IRF:
-
Inpatient rehabilitation facilities
- ESUS:
-
Extended stroke unit services
- OSUS:
-
Ordinary stroke unit services
- PSC:
-
Post-stroke care
- PM:
-
Patient month
- GDP:
-
Gross domestic product
- AUD:
-
Australian Dollar
- CAD:
-
Canadian Dollar
- DM:
-
Deutsche Mark
- SEK:
-
Swedish Krona
- CHF:
-
Swiss Franc
- £:
-
UK Pound
- $, USD:
-
US Dollar
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This work was supported by the Erasmus-Western Balkans mobility programme (ERAWEB), a project funded by the European Commission. The funding source had no influence on study design, analysis and interpretation of data, in the writing of the manuscript and the decision to submit the manuscript for publication.
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This work was approved by the Research Committee for Scientific and Ethical Questions (RCSEQ), University for Health Sciences, Medical Informatics and Technology (UMIT), Hall in Tirol, Austria (Date: April 26, 2016; reference number: 1697).
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Rajsic, S., Gothe, H., Borba, H.H. et al. Economic burden of stroke: a systematic review on post-stroke care. Eur J Health Econ 20, 107–134 (2019). https://doi.org/10.1007/s10198-018-0984-0
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DOI: https://doi.org/10.1007/s10198-018-0984-0