Introduction
Methods
Search strategy
Analysis and sources
Analysis of direct cost
Analysis of indirect costs
Results
HEALTH CARE SYSTEM COST | COST Nonrelated with Health CARE SYSTEM Cost | PRODUCTIVITY COSTS | ||||||
---|---|---|---|---|---|---|---|---|
Author, year, country | PP | ACUTE STROKE | POST ICTUS | SOCIAL CARE | PATIENTS AND CAREGIVERS COST | MORBIDITY LOSSES | MORTALITY LOSSES | |
HTA | AF | |||||||
Wodchis WP, 2011 (Canada) [30] | X | |||||||
Cotte,2016 (France) [31] | X | |||||||
López-López 2017, (UK) [32] | X | |||||||
Giner-Soriano, 2020 (Spain) [33] | X | |||||||
Zhang, 2017, (EEUU)[34] | X | |||||||
Gheorghe, 2018 (UK) [35] | X | |||||||
Kostova, 2020 (EEUU) [36] | X | |||||||
Salvatore, 2021 (Italy) [29] | X | X | ||||||
Shireman TI,2017 (EEUU) [37] | X | |||||||
Zhang H, 2019 (China), [38] | X | X | ||||||
Abdo RR, 2018 (Leban)[20] | X | |||||||
Reimer AP, 2019 [39] | X | |||||||
De Andres 2014 (Spain) [40] | X | X | ||||||
Van Meijeren-Pont W, 2016 [41] | X | X | ||||||
Oliva-Moreno, 2013 (Spain) [42] | X | |||||||
Skolarus, 2016 (EEUU) [43] | X | |||||||
Joo H, 2017 (EEUU) [3] | X | |||||||
Alvarez-Sabin, 2013, (Spain) [44] | X | X | X | |||||
Van Eeden, 2015 (Netherlands) [45] | X | X | X | X | X | |||
Xu. 2018 (UK) [46], | X | X | X | X | X | X | ||
Benjamin. 2019 (EEUU)[4] | X | X | X | X | ||||
Luengo-Fernandez, 2020 (UK) [2], | X | X | X | X | X | X | ||
Patel A, 2020(UK) [47] | X | X | X | X | X | X | ||
Rochmah TN., 2021 (Indonesia) [48] | X | X | X | X | X | X | ||
Stefan Strilciuc, 2021 Romania [49] | X | X | X | X | X | X |
Stroke primary prevention (Table 2)
First Author Year of publication Country | Objectives | Methods | Results | |||
---|---|---|---|---|---|---|
Design and
GRADE LEVEL [32] |
Participants
|
Instruments
|
Calculated stroke costs
| |||
Wodchis WP, 2011 (Canada) [30] | Review and synthesize the literature on the costs of atrial fibrillation (AF) | Systematic review
1 + GRADE
| 115 articles | FA related direct costs | Direct Costs | Average cost: 4750 € (1224€—15,824 €) |
Cotte, 2016 (France) [31] | To investigate the annual burden of cardiovascular complications in AF | Retrospective longitudinal population-based study
2 + GRADE
| 533,044 AF patients | Stroke related to AF hospitalizations, global burden | Direct Costs | Cost per patient: Hemorrhagic stroke (€12,748), ischemic stroke (€11,234), Systemic Embolism (€9087), unspecified stroke (€8108), and Transient Ischemic Attack (€3734) |
López-López, 2017 (UK), [32] | To compare Direct Oral Anti-Coagulants (DOACs) with each other and with warfarin for prevention of stroke in patients with AF | Systematic review, network meta-analysis, and cost effectiveness analysis
1 + GRADE
| 94,656 patients with AF 23 randomized trials involving | Cost effectiveness of preferred licensed products | Direct Costs | Total average cost per patient/year was between €23,064 from €24,841 per patient /year |
Giner-Soriano, 2020 (Spain), [33] | To analyze the use, effectiveness, safety and costs of stroke prevention in AF in patients with dabigatran or vitamin K antagonists (AVK) | Observational study of population-based cohorts
2 + GRADE
| 14,930 patients with AF | Consumption of healthcare resources and costs associated with the management of atrial fibrillation | Direct Costs | Average cost of €4075.60 in the group treated with dabigatran Average cost of €4551.40 in the AVK group |
Zhang, 2017 (EEUU) [34] | To summarize evidence on cost effectiveness of community-based interventions to control hypertension based on a review | Systematic review
1 + GRADE
| 64 articles | -cost-effectiveness analysis; -cost–benefit analysis | Direct Costs | Average cost €51,5 ( €33–€94,05) for 1-mmHg reduction in systolic blood pressure (SBP) and €11,538 ( €5513-€48,353) for 1 life-year gained Screening interventions cost from €17,930 to €46,818 in the U.S., €505 to €4650in Australia, and €5755 to €14,850 in China |
Gheorghe, 2018 (UK), [35] | To Synthetize the economic burden of Cardiovascular Disease (CVD) and hypertension | Systematic review
1 + GRADE
| 83 articles | Total costs for HTA treatment in each CVD | Direct Costs | Average costs for hypertension:€18,15 per month |
Kostova, 2020 (EEUU) [36] | Review and synthesize the literature on the costs of HTA | Systematic review
1 + GRADE
| 70 articles | HTA related direct costs | Direct Costs | The range of the annual intervention per hypertension patient was from €5,16 for a non-drug program to €2014,2 for a Pharm program |
Salvatore, 2021 (Italy)[29] | To investigate the costs of cardiovascular disease in the regional health service in Italy's from 2014 to 2016 | Retrospective longitudinal population-based study
2 + GRADE
| 98,829 patients | Cardiovascular complications related to AF hospitalizations, global burden | Direct Costs | Atrial Fibrillation costs range from €3724,67 to €4328,88 |
Acute care for a stroke (Table 3)
First Author Year of publication Country | Objectives | Methods | Results | |||
---|---|---|---|---|---|---|
Design
GRADE LEVEL [32] |
Participants
|
Instruments
|
Calculated stroke costs
| |||
Shireman TI, 2017 (EEUU) [37] | Demonstrate improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST + tPA) compared with tPA | Prospective economic study
2 + GRADE
| 196 patients | Cost-effectiveness from the perspective of the US healthcare system | Direct costs | Total 90-day costs: - SST + tPA: €52,468,5 - tPA: €41,171 |
Abdo RR, 2018 (Lebanon) [20] | To investigate the direct Medical Cost of Hospitalization | Prospective Incidence-Based Multicenter
2 + GRADE
| 230 patients | Cost-of-Illness Study | Direct costs | The average in-hospital cost per stroke patient was €5798,15 ± €113,047 |
Zhang H, 2019 (China), [49] | To investigate the total direct hospitalization costs of stroke. These costs include laboratory and diagnostic costs, medications costs, bed fees and services | Cross-sectional study from 2006 to 2013
2 + GRADE
| 114,872 hospitalizations for five stroke types | Databases of Guangzhou City for the years 2006 through 2013 | Direct costs | The average cost of hospitalization for stroke patients was €2328,77 |
Reimer AP, 2019 (EEUU)[39] | To perform a cost consequence analysis of standard transport (ST) vs. Mobile Stroke Unit (MSU) | Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport | Standard emergency medical services between July 2014 and October 2015 for 400 patient transports MSU | Cleveland Clinic Mobile Stroke Unit | Direct costs | The incremental cost of the MSU vs. ST was €86,134 cost of air transfer (> €11,303.30) |
De Andres, 2014 (Spain) [40] | To estimate the use of healthcare resources and costs of acute Cardioembolic Stroke management | Estudio CODICE. multicenter prospective observational study
2 + GRADE
| 128 patients | Spanish National Health System | Direct costs | Average total cost per patient during acute-phase management and rehabilitation was €13,139 |
Van Meijeren-Pont W, 2016 (Netherlands) [41] | To estimate societal costs up to one year after the start of rehabilitation | Stroke Cohort Out-comes of REhabilitation (SCORE) study | 313 stroke patients | 2014 to 2016 | Mean cost out-patient rehabilitation for 12 months | Mean costs for inpatient and outpatient rehabilitation were €86,133 and €33,517 respectively |
Transfer to stroke care unit vs emergency department
Post-acute stroke (Table 4)
First Author Year of publication Country | Objectives | Methods | Results | |||
---|---|---|---|---|---|---|
Design and
GRADE LEVEL [32] |
Participants
|
Instruments
|
Calculated stroke costs
| |||
Oliva-Moreno, 2013 (Spain) [42] | Estimate the social cost of non-professional (informal) care provided to survivors of cerebrovascular accidents (CVA) | Prospective economic study
2 + GRADE
| 329,544 people | 2008 Survey on Disability, Independent Living and Dependency (EDAD-08) | Indirect costs calculating each hour of care at 12.71 euros | The estimated hours of informal care provided in 2008 amounted to 852 million € |
Skolarus, 2016 (EEUU) [43] | To investigate the annual cost of stroke caregiving | Cross sectional study
2 + GRADE
| 892 patients | National Health and Aging Trends Study (NHATS), a nationally representative survey of Medicare beneficiaries | Indirect costs calculating each hour of care at 6,55 euros/hour | Average annual cost for caregiving for an elderly stroke survivor was €8712 22.3 h/week |
Joo H, 2017 (EEUU) [3] | To describe the Economic burden of informal caregiving associated with stroke | Systematic Review
1 + GRADE
| 10,129 patients 6 articles | 2010 Health and Retirement Study, data on non-institutionalized adults aged ≥ 65 years | Indirect costs calculating each hour of care at 10,54 euros/hour | €4332 per year (95% CI: €1685-€6514) for informal caregiving |
Secondary cardiovascular prevention
Socio-sanitary (formal care)
Non-healthcare system costs
Global average stroke cost (Table 5)
First Author Year of publication Country | Objectives | Methods | Results | |||
---|---|---|---|---|---|---|
Design and
GRADE LEVEL[32] |
Participants
|
Instruments
|
Calculated stroke costs
| |||
Alvarez-Sabin, 2013 (Spain) [44] | To find the cost of stroke in Spain | Epidemiological, observational, prospective, multicenter study
2 + GRADE
| 321 patients | Sociodemographic, clinical, and economic data | Direct costs Indirect costs | Total average cost per patient/year was €27,711. Direct healthcare costs €849 patient/year and non-healthcare costs to an average of €18,643patient/year. Productivity loss costs per patient/year were €276 |
Van Eeden, 2015 (Netherlands) [45] | Explore over 1 year poststroke the societal costs, changes in costs and quality of life (QoL) and the relation between costs and QoL | Epidemiological, observational, prospective, multicenter study
2 + GRADE
| 395 patients | Cost-of-illness (in Euros) and QoL (in utilities) of a disease | Direct costs Indirect costs | Indirect cost = €11,416 Direct cost = €18,068 Total societal costs for 1 year poststroke were €29 484 |
Xu, 2018 (UK), [46] | To estimate patient-level health and social care costs of stroke for all patients admitted to hospital with stroke in UK | Epidemiological, observational Retrospective Health economic simulation
2 + GRADE
| 111,846 patients | Health Care Costs Productivity Costs | Direct costs Indirect costs | The estimated stroke cost varied widely according to patient characteristics, ranging from €8149 to €49,922 at one year and €21,259 to €119,464 at five years |
Benjamin. 2019 (EEUU) [4] | To estimate the cost of Cardio Vascular Diseases and risk factors | Statistical update
2 + GRADE
| 18,462 patients | Health interview surveys | Direct costs Indirect costs | Direct care €6673 /patient/year Post ictus Care €9412/patient/year |
Luengo-Fernandez. 2020 (UK) [2] | To provide an estimate of the overall economic costs of stroke for all 28 countries of the EU | Population-based cost analysis
2 + GRADE
| 1,5 million patients 32 European countries | Population-based cost analysis | Direct costs Indirect costs | Health Care: €17,728 /patient/year Social Care: €3165/patient/year Productivity costs: €8336/ patient/year Informal care costs: €10,508/ patient/year Total costs: €39,736,66 /patient/year |
Patel A, 2020 (UK) [47] | To estimate 2014/2015 annual cost from a societal perspective | Epidemiological retrospective study
2 + GRADE
| 331 patients | Annual mean cost per person and aggregate UK cost of stroke for individuals aged ≥ 40 Health and social costs | Direct costs Indirect costs | Mean cost of new-onset stroke is €61,665 (95% CI €57,109-€66,220) in the first year after stroke and €33,648 (€27,477-€39,819) in subsequent years |
Rochmah TN, 2021 Indonesia [48] | To analyze the burden of stroke: analyzing the average length of hospitalization, and the magnitude of economic losses due to stroke | Systematic review
1 + GRADE
| 13 articles | Cost of illness studies that assess burden of stroke in primary and referral healthcare (hospital-based) Direct and indirect costs | Direct costs Indirect costs | The economic burden of stroke disease based on cost of illness method, which is approximately equal to € 1478- €265,613 (direct costs 86.2%, and indirect costs 13.8%) |
Stefan Strilciuc, 2021 Romania[49] | To compile the results of existing studies on the economic burden of stroke, | Systematic review
1 + GRADE
| forty-six articles published in twenty-three countries between 1994 and 2019 | Across all cost perspectives | Overall costs | Costs in the per patient per year category varied from €103,578 in South Korea (for hemorrhagic stroke) to €610 in Singapore |