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The hidden cost of strokes

Professor Alistair McGuire unravels the complex economics behind Europe's most common cause of disability

Stroke patients cost the British economy nearly £9billion a year and more needs to be done to ensure efficient use of resources devoted to cost-effective treatments, according to LSE research. 

The illness is the second most common cause of death and the leading cause of disability in Europe. Long-term disability is a significant problem, leaving many sufferers dependent on others to care for them. With an ageing UK population the costs are likely to increase significantly.image of orange pills 

Two studies by Professor Alistair McGuire at LSE and colleagues from King's College, London conclude that cost-effective provision of care could be improved and further research is needed to ensure that there is an efficient use of resources devoted to the treatment of this disease. 

They found that the treatment of and productivity loss arising from stroke results in total costs of £8.9 billion a year. Direct care accounts for around 50 per cent of the total, informal care costs 27 per cent and the indirect costs are 24 per cent. The £4 billion treatment costs accounts for around 5 per cent of the total spent by the NHS. 

The research estimated the costs using data from the South London Stroke Register, based on 3000 patients in that area, and other national sources. 

By differentiating between acute and chronic treatment phases, the study was able to highlight the burden of informal care and lost productivity. This highlights the importance of the chronic treatment phase and the need to develop better understanding of long-term care in terms of its effectiveness and cost-effectiveness. 

The study assessed the cost-effectiveness of stroke unit (SU) care followed by early supported discharge (ESD). Treatment of stroke patients in SUs is becoming a standard treatment approach. This means that patients should be admitted under the care of a specialist team for their acute care and rehabilitation.  

Despite the growth and standardisation of this approach, there has been little health economics research on its cost and cost-effectiveness. Evidence exists as to the benefits of SUs in the acute treatment phase of stroke, but is less conclusive regarding the effective management of discharge and follow-up after acute care. Early supported discharge (ESD) offers an effective care pathway, where less disabled patients can be discharged early to undergo further rehabilitation at home. 

Existing evidence suggests that appropriately resourced ESD services could reduce long-term dependency and admission to institutional care, as well as reduce the length of hospital stay without causing any adverse effects. 

The study aimed to evaluate the long-term (ten-year) cost-effectiveness of SU care followed by ESD compared with SU care and treatment in a general medical ward with no ESD. The analysis showed that when SU options were compared with the general medical ward option, they were more cost-effective, and when the two SU options were compared, SU with ESD was most effective. 

The incremental cost-effectiveness ratio (ICER) value for SU unit with early supported discharge was £17,721, which falls below the National Institute for Health and Clinical Excellence's cost-effectiveness threshold level of £30,000 per quality -adjusted life year (QALY) gained. 

The prevalence and hence the burden of stroke is expected to grow in the future as a result of the increase in the proportion of older people. Therefore, cost of illness studies have to be updated to understand the economics of the disease and its changing cost structure. This will enable policy makers to allow better-informed distribution of resources for cost-effective treatment of an illness that places a significant burden on the economy.


Useful links

Cost of stroke in the United Kingdom [PDF] is published by Oxford University Press on behalf of the British Geriatrics Society. 

For full details of Professor Alistair McGuire's research and publications see Alistair McGuire's entry in the LSE Experts Directory: Professor Alistair McGuire|