Published online before print May 3, 2007, doi: 10.1161/STROKEAHA.107.491092
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(Stroke. 2007;38:1732.)
© 2007 American Heart Association, Inc.
Editorials |
The Economics of Thrombolysis
From the Department of Clinical Neurosciences, Division of Neurology, University of Calgary (M.D.H.), and the Department of Medicine, Division of Neurology, University of Ottawa (M.S.), Canada.
Correspondence to Michael D. Hill, University of Calgary, Rm 1242A, Foothills Medical Centre,1403 29th Street NW, Calgary, Alberta, Canada T2N 2T9. E-mail michael.hill@calgaryhealthregion.ca
See related article, pages 1952–1955.
Key Words: acute Rx • acute stroke • economics • thrombolysis • thrombolytic RX
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
Stroke leads to significant long-term disability with important ongoing human and economic costs. Although the clinical and economic benefits of thrombolysis have been demonstrated in previous analyses,1 efficacious large volume stroke care requires systematic organization and commitment on the part of healthcare payers. Canada benefits from a universal single-payer system which faces increasing cost pressures attributable to an ageing population and increasing costs of healthcare technology. The Organization for Economic Cooperation and Development (OECD) estimates that healthcare spending could double as a proportion of GDP in this country by 2050.2 The Canadian Institutes of Health Information note that Canadian jurisdictions spent 38.7% of all expenditures on health care in 2005 to 2006.3 Development and maintenance of stroke care systems will require well executed economic analyses to influence policy makers.
In this regard, stroke is an ideal condition to treat from an economic perspective because its incidence is strongly age-linked and any intervention that reduces disability is likely to substantially reduce long-term costs. However, any treatment that reduces mortality but leaves disability may increase total costs attributable to the high cost of long-term nursing care of brain-injured patients.
Stroke thrombolysis has not been shown to reduce mortality. In the pivotal National Institute of Neurological Disorders and Stroke tissue plasminogen activator (NINDS tPA) Stroke Trial, a nonsignificant 4% reduction in mortality was observed, but this was not confirmed in the pooled analysis of randomized controlled trials. However, thrombolysis does reduce morbidity. Previous cost-effectiveness analyses have suggested large cost-savings per patient treated even
Related Article:
Stroke 2007 38: 1952-1955.