Lars-Åke Marké

Costs of stroke in Sweden. A national perspective.

Cost-effectiveness analyses of stroke management are hampered by paucity of economic data. We made an update of the direct and indirect costs of stroke in Sweden (population, 8.5 million). Methods Direct costs (ie, the costs for hospital and outpatient care and social services) were estimated on the basis of two prospective population-based studies of stroke and of two nationwide cross-sectional inventories of bed-days and diagnoses. Indirect costs (ie, the costs for loss of productivity and early retirement) were based on official statistics. Results The direct annual costs of care for stroke patients in 1991 equaled 7836 million Swedish krona (SKr) (

Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective.

1306 million in US dollars), and the indirect costs, 2430 million SKr (

Immediate computed tomography or admission for observation after mild head injury: cost comparison in randomised controlled trial

405 million). The cost of stroke care was 1208 SKr (

Costs and Gains in Stroke Prevention: European Perspective

201) per inhabitant in Sweden. The expected direct costs per patient from first stroke to death were 440 000 SKr (

CAT scanners: the Swedish experience.

73 333). When prestroke costs for other diseases and advanced age were subtracted, the sum was reduced to 180 000 SKr (

Triage och flödesprocesser på akutmottagningen : En systematisk litteraturöversikt

30 000). Conclusions Costs for hospital and outpatient care and social services accounted for 76% of Swedish stroke costs and for 24% of costs for loss of production and early retirement. Only 41% of direct costs were stroke-related.

Diagnosing Suspected Stroke: A Cost-Effectiveness Analysis

OBJECTIVE--To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population. DESIGN--Analysis of cost effectiveness based on the following assumptions: about 83,000 people have atrial fibrillation in Sweden, of whom 22,000 would be potential candidates for treatment with anticoagulants and 55,000 for aspirin treatment; the annual 5% stroke rate is reduced by 64% (with anticoagulants) and 25% (with aspirin); incidence of intracranial haemorrhage of 0.3%, 1.3%, or 2.0% per year; direct and indirect costs of a stroke of Kr180,000 and Kr90,000; estimated annual cost of treatment is Kr5030 for anticoagulants and Kr100 for aspirin. SETTING--Total Swedish population. MAIN OUTCOME MEASURES--Direct and indirect costs of stroke saved, number of strokes prevented, and cost of preventive treatment. RESULTS--Depending on the rate of haemorrhagic complications 34 to 83 patients would need to be treated annually with anticoagulants to prevent one stroke; 83 patients would need to be treated with aspirin. Giving anticoagulant treatment only would reduce costs by Kr60 million if the incidence of intracranial haemorrhage were 0.3% but would imply a net expense if the complication rate exceeded 1.3%. The total savings from giving anticoagulant (22,000 patients) and aspirin (55,000 patients) treatment would be Kr175 million per year corresponding to 2 million pounds per million inhabitants each year. CONCLUSIONS--Treatment with anticoagulants and, if contraindications exist, with aspirin is cost effective provided that the risk of serious haemorrhage complications due to anticoagulants is kept low.

SBU planerar prospektiv studie om commotio

Abstract Objective To compare the costs of immediate computed tomography during triage for admission with those of observation in hospital in patients with mild head injury. Design Prospective cost effectiveness analysis within a multicentre, pragmatic randomised trial. Setting 39 acute hospitals in Sweden Participants 2602 patients (aged ≥ 6) with mild head injury. Interventions Immediate computed tomography or admission for observation. Main outcome measures Direct and indirect costs related to the mild head injury during the acute and three month follow-up period. Results Outcome after three months was similar for both strategies (non-significantly in favour of computed tomography). For the acute stage and complications, the cost was 461 euros (£314,

DATORTOMOGRAFI ALTERNATIV TILL OBSERVATION VID HJARNSKAKNING

582) per patient in the computed tomography group and 677 euros (£462,

Author Index / Subject Index Vol. 2, 1992

854) in the observation group; an average of 32% less in the computed tomography group (216 euros, 95% confidence interval −272 to −164; P < 0.001). Sensitivity analysis showed that computed tomography was the most cost effective strategy under a broad range of assumptions. After three months, total costs were 718 euros and 914 euros per patient—that is, 196 euros less in the computed tomography group (- 281 to - 114; P < 0.001). The lower cost of the computed tomography strategy at the acute stage thus remained unchanged during follow-up. Conclusion Patients with mild head injury attending an emergency department can be managed more cost effectively with computed tomography rather than admission for observation in hospital. Trial registration ISRCTN81464462 [controlled-trials.com].