International Comparisons of Stroke Costs Are Always Limited
To the Editor:
First, 20% of patients with spasticity were prescribed benzodiazepines for various indications; no patient received baclofen, dantrolene, or tizanidine; and no patient had been treated by botulinum toxin. This finding was unexpected and might reflect reluctance to use oral drugs with a less favorable effect or side effect ratio in patients with cerebral as compared with spinal disorders and that treatment by intramuscular injection of botulinum toxin had still not been established during the study period as well as poor diagnostic routines. We fully agree that effective treatment of spasticity might have an impact on costs, which is indeed an important area for further studies.
Second, the cost of health care in the United States is higher then Europe. Professor Reinhardt at Princeton University has highlighted this fact in 2 articles on the Internet.3,4 Although 86% of the costs can be explained with gross domestic product per capita, he points out 4 possible explanations to the difference: (1) higher prices for the same healthcare goods and services; (2) significantly higher administrative overhead costs; (3) more widespread use of high-cost, high-tech equipment and procedures than are used in other countries; and (4) costs triggered by the uniquely US tort laws, which in the context of medicine can lead to “defensive medicine,” that is, the application of tests and procedures mainly as a defense against possible malpractice litigation rather than as a clinical imperative.
Finally, there are 3 errors in the Editorial,1 2 minor and 1 major. Minor: The reference from Jorgensen et al5 should be dated 1997 (not 2008), and in the Table, Sweeden should read Sweden. The major error is the conversion for the cost for Denmark. In their Table,1 column 4, row 3, they have stated the costs for spastic stroke, local currency as 7 188 759 DEK. It should read 718 759 DEK.2 If you convert 718 759 DEK into US dollars at the exchange rate of 5.82, it equals $123 498 US (not $1 235 181.98 US). In summary, the cost does not differ much between Sweden and Denmark whether you use PPP$ or US dollars.
Low RB, Qureshi AI, Low DC. Limits to international estimates of stroke costs. Stroke. 2010; 41: 201–202.
Lundström E, Smits A, Borg J, Terént A. Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event. Stroke. 2010; 41: 319–324.
Reinhardt UE. Why Does US Health Care Cost So Much? (Part I). 2008. Available at: http://economix.blogs.nytimes.com/2008/11/14/why-does-us-health-care-cost-so-much-part-i/?scp=1&sq=Why%20Does%20US%20Health%20Care%20Cost%20So%20Much&st=Search.
Reinhardt UE. Why Does US Health Care Cost So Much? (Part II: Indefensible Administrative Costs). 2008. Available at: http://economix.blogs.nytimes.com/2008/11/21/why-does-us-health-care-cost-so-much-part-ii-indefensible-administrative-costs/?scp=7&sq=Why%20Does%20U.S.%20Health%20Care%20Cost%20So%20Much&st=Search. Accessed on May 4, 2010.
Jørgensen HS, Nakayama H, Raaschou HO, Olsen TS. Acute stroke care and rehabilitation: an analysis of the direct cost and its clinical and social determinants: the Copenhagen Stroke Study. Stroke. 1997; 28: 1138–1141.