Stroke, Vol. 37, No. 5. (1 May 2006), pp. 1179-1183.
Background and Purpose-- The number of stroke patients and the healthcare costs of strokes are expected to rise. The objective of this study was to determine the direct costs of first ischemic stroke and to estimate the expected increase in costs in Germany. Methods-- An incidence-based, bottom-up, direct-cost-of-ischemic-stroke study from the third-party payer's perspective was performed, incorporating 10-year survival data and 5-year resource use data from the Erlangen Stroke Registry. Discounted lifetime year 2004 costs per case were obtained and applied to the expected age and sex evolution of the German resident population in the period 2006 to 2025. Results-- The overall cost per first-year survivor of first-ever ischemic stroke was estimated to be 18 517 euros (EUR). Rehabilitation accounted for 37% of this cost, whereas in subsequent years outpatient care was the major cost driver. Discounted lifetime cost per case was 43 129 EUR overall and was higher in men (45 549 EUR) than in women (41 304 EUR). National projections for the period 2006 to 2025 showed 1.5 million and 1.9 million new cases of ischemic stroke in men and women, respectively, at a present value of 51.5 and 57.1 billion EUR, respectively. Conclusions-- The number of stroke patients and the healthcare costs of strokes in Germany will rise continuously until the year 2025. Therefore, stroke prevention and reduction of stroke-related disability should be made priorities in health planning policies. 10.1161/01.STR.0000217450.21310.90
Peter Kolominsky-Rabas, Peter Heuschmann, Daniela Marschall, Martin Emmert, Nikoline Baltzer, Bernhard Neundorfer, Oliver Schoffski, Karl Krobot, For
Lifetime Cost of Ischemic Stroke in Germany: Results and National Projections From a Population-Based Stroke Registry: The Erlangen Stroke Project
Stroke, Syndicated
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Mar 292009
Stroke, Vol. 37, No. 5. (1 May 2006), pp. 1179-1183.Lifetime Cost of Ischemic Stroke in Germany: Results and National Projections From a Population-Based Stroke Registry: The Erlangen Stroke Project
Stroke, Syndicated
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Mar 292009
Stroke, Vol. 37, No. 5. (1 May 2006), pp. 1179-1183.
Background and Purpose-- The number of stroke patients and the healthcare costs of strokes are expected to rise. The objective of this study was to determine the direct costs of first ischemic stroke and to estimate the expected increase in costs in Germany. Methods-- An incidence-based, bottom-up, direct-cost-of-ischemic-stroke study from the third-party payer's perspective was performed, incorporating 10-year survival data and 5-year resource use data from the Erlangen Stroke Registry. Discounted lifetime year 2004 costs per case were obtained and applied to the expected age and sex evolution of the German resident population in the period 2006 to 2025. Results-- The overall cost per first-year survivor of first-ever ischemic stroke was estimated to be 18 517 euros (EUR). Rehabilitation accounted for 37% of this cost, whereas in subsequent years outpatient care was the major cost driver. Discounted lifetime cost per case was 43 129 EUR overall and was higher in men (45 549 EUR) than in women (41 304 EUR). National projections for the period 2006 to 2025 showed 1.5 million and 1.9 million new cases of ischemic stroke in men and women, respectively, at a present value of 51.5 and 57.1 billion EUR, respectively. Conclusions-- The number of stroke patients and the healthcare costs of strokes in Germany will rise continuously until the year 2025. Therefore, stroke prevention and reduction of stroke-related disability should be made priorities in health planning policies. 10.1161/01.STR.0000217450.21310.90
Peter Kolominsky-Rabas, Peter Heuschmann, Daniela Marschall, Martin Emmert, Nikoline Baltzer, Bernhard Neundorfer, Oliver Schoffski, Karl Krobot, For
Background and Purpose-- The number of stroke patients and the healthcare costs of strokes are expected to rise. The objective of this study was to determine the direct costs of first ischemic stroke and to estimate the expected increase in costs in Germany. Methods-- An incidence-based, bottom-up, direct-cost-of-ischemic-stroke study from the third-party payer's perspective was performed, incorporating 10-year survival data and 5-year resource use data from the Erlangen Stroke Registry. Discounted lifetime year 2004 costs per case were obtained and applied to the expected age and sex evolution of the German resident population in the period 2006 to 2025. Results-- The overall cost per first-year survivor of first-ever ischemic stroke was estimated to be 18 517 euros (EUR). Rehabilitation accounted for 37% of this cost, whereas in subsequent years outpatient care was the major cost driver. Discounted lifetime cost per case was 43 129 EUR overall and was higher in men (45 549 EUR) than in women (41 304 EUR). National projections for the period 2006 to 2025 showed 1.5 million and 1.9 million new cases of ischemic stroke in men and women, respectively, at a present value of 51.5 and 57.1 billion EUR, respectively. Conclusions-- The number of stroke patients and the healthcare costs of strokes in Germany will rise continuously until the year 2025. Therefore, stroke prevention and reduction of stroke-related disability should be made priorities in health planning policies. 10.1161/01.STR.0000217450.21310.90
Peter Kolominsky-Rabas, Peter Heuschmann, Daniela Marschall, Martin Emmert, Nikoline Baltzer, Bernhard Neundorfer, Oliver Schoffski, Karl Krobot, For
Mar 292009
The New England journal of medicine, Vol. 355, No. 6. (10 August 2006), pp. 549-559.
Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack (TIA) remains to be established. We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry, had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter (2.6 to 4.9 mmol per liter), and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo. The primary end point was a first nonfatal or fatal stroke. The mean LDL cholesterol level during the trial was 73 mg per deciliter (1.9 mmol per liter) among patients receiving atorvastatin and 129 mg per deciliter (3.3 mmol per liter) among patients receiving placebo. During a median follow-up of 4.9 years, 265 patients (11.2 percent) receiving atorvastatin and 311 patients (13.1 percent) receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin. In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].). Copyright 2006 Massachusetts Medical Society.
Pierre Amarenco, Julien Bogousslavsky, Alfred Callahan, Larry Goldstein, Michael Hennerici, Amy Rudolph, Henrik Sillesen, Lisa Simunovic, Michael Szarek, KM Welch, Justin Zivin,
Statins reduce the incidence of strokes among patients at increased risk for cardiovascular disease; whether they reduce the risk of stroke after a recent stroke or transient ischemic attack (TIA) remains to be established. We randomly assigned 4731 patients who had had a stroke or TIA within one to six months before study entry, had low-density lipoprotein (LDL) cholesterol levels of 100 to 190 mg per deciliter (2.6 to 4.9 mmol per liter), and had no known coronary heart disease to double-blind treatment with 80 mg of atorvastatin per day or placebo. The primary end point was a first nonfatal or fatal stroke. The mean LDL cholesterol level during the trial was 73 mg per deciliter (1.9 mmol per liter) among patients receiving atorvastatin and 129 mg per deciliter (3.3 mmol per liter) among patients receiving placebo. During a median follow-up of 4.9 years, 265 patients (11.2 percent) receiving atorvastatin and 311 patients (13.1 percent) receiving placebo had a fatal or nonfatal stroke (5-year absolute reduction in risk, 2.2 percent; adjusted hazard ratio, 0.84; 95 percent confidence interval, 0.71 to 0.99; P=0.03; unadjusted P=0.05). The atorvastatin group had 218 ischemic strokes and 55 hemorrhagic strokes, whereas the placebo group had 274 ischemic strokes and 33 hemorrhagic strokes. The five-year absolute reduction in the risk of major cardiovascular events was 3.5 percent (hazard ratio, 0.80; 95 percent confidence interval, 0.69 to 0.92; P=0.002). The overall mortality rate was similar, with 216 deaths in the atorvastatin group and 211 deaths in the placebo group (P=0.98), as were the rates of serious adverse events. Elevated liver enzyme values were more common in patients taking atorvastatin. In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].). Copyright 2006 Massachusetts Medical Society.
Pierre Amarenco, Julien Bogousslavsky, Alfred Callahan, Larry Goldstein, Michael Hennerici, Amy Rudolph, Henrik Sillesen, Lisa Simunovic, Michael Szarek, KM Welch, Justin Zivin,
Mar 292009
The New England journal of medicine, Vol. 355, No. 6. (10 August 2006), pp. 549-559.
In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].).
Pierre Amarenco, Julien Bogousslavsky, Alfred Callahan, Larry Goldstein, Michael Hennerici, Amy Rudolph, Henrik Sillesen, Lisa Simunovic, Michael Szarek, KM Welch, Justin Zivin,
In patients with recent stroke or TIA and without known coronary heart disease, 80 mg of atorvastatin per day reduced the overall incidence of strokes and of cardiovascular events, despite a small increase in the incidence of hemorrhagic stroke. (ClinicalTrials.gov number, NCT00147602 [ClinicalTrials.gov].).
Pierre Amarenco, Julien Bogousslavsky, Alfred Callahan, Larry Goldstein, Michael Hennerici, Amy Rudolph, Henrik Sillesen, Lisa Simunovic, Michael Szarek, KM Welch, Justin Zivin,
Association of a clinical knowledge support system with improved patient safety, reduced complications and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States
Medicare News, Syndicated
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Mar 182009
International Journal of Medical Informatics, Vol. In Press, Corrected Proof
Background Electronic clinical knowledge support systems have decreased barriers to answering clinical questions but there is little evidence as to whether they have an impact on health outcomes.Methods We compared hospitals with online access to UpToDate? with other acute care hospitals included in the Thomson 100 Top Hospitals? Database (Thomson database). Metrics used in the Thomson database differentiate hospitals on a variety of performance dimensions such as quality and efficiency. Prespecified outcomes were risk-adjusted mortality, complications, the Agency of Healthcare Research and Quality Patient Safety Indicators, and hospital length of stay among Medicare beneficiaries. Linear regression models were developed that included adjustment for hospital region, teaching status, and discharge volume.Results Hospitals with access to UpToDate? (n?=?424) were associated with significantly better performance than other hospitals in the Thomson database (n?=?3091) on risk-adjusted measures of patient safety (P?=?0.0163) and complications (P?=?0.0012) and had significantly shorter length of stay (by on average 0.167 days per discharge, 95% confidence interval 0.081-0.252 days, P?\\textless?0.0001). All of these associations correlated significantly with how much UpToDate? was used at each hospital. Mortality was not significantly different between UpToDate? and non-UpToDate? hospitals.Limitations The study was retrospective and observational and could not fully account for additional features at the included hospitals that may also have been associated with better health outcomes.Conclusions An electronic clinical knowledge support system (UpToDate?) was associated with improved health outcomes and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Additional studies are needed to clarify whether use of UpToDate? is a marker for the better performance, an independent cause of it, or a synergistic part of other quality improvement characteristics at better-performing hospitals.
Peter Bonis, Gary Pickens, David Rind, David Foster
Background Electronic clinical knowledge support systems have decreased barriers to answering clinical questions but there is little evidence as to whether they have an impact on health outcomes.Methods We compared hospitals with online access to UpToDate? with other acute care hospitals included in the Thomson 100 Top Hospitals? Database (Thomson database). Metrics used in the Thomson database differentiate hospitals on a variety of performance dimensions such as quality and efficiency. Prespecified outcomes were risk-adjusted mortality, complications, the Agency of Healthcare Research and Quality Patient Safety Indicators, and hospital length of stay among Medicare beneficiaries. Linear regression models were developed that included adjustment for hospital region, teaching status, and discharge volume.Results Hospitals with access to UpToDate? (n?=?424) were associated with significantly better performance than other hospitals in the Thomson database (n?=?3091) on risk-adjusted measures of patient safety (P?=?0.0163) and complications (P?=?0.0012) and had significantly shorter length of stay (by on average 0.167 days per discharge, 95% confidence interval 0.081-0.252 days, P?\\textless?0.0001). All of these associations correlated significantly with how much UpToDate? was used at each hospital. Mortality was not significantly different between UpToDate? and non-UpToDate? hospitals.Limitations The study was retrospective and observational and could not fully account for additional features at the included hospitals that may also have been associated with better health outcomes.Conclusions An electronic clinical knowledge support system (UpToDate?) was associated with improved health outcomes and shorter length of stay among Medicare beneficiaries in acute care hospitals in the United States. Additional studies are needed to clarify whether use of UpToDate? is a marker for the better performance, an independent cause of it, or a synergistic part of other quality improvement characteristics at better-performing hospitals.
Peter Bonis, Gary Pickens, David Rind, David Foster
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