Chapter 1

Epidemiology and Social Costs

Simone Peschillo and Francesco Diana

Abstract

Stroke is a pathology that has a heavy socio-economic impact, considering that the annual incidence is 15 million new cases and only one-third of these has a positive clinical outcome. Stroke is the cause of 4% of all disabilities and it does, therefore, have very high indirect social costs. The purpose of this chapter is to analyse the societal costs of stroke and compare the various treatments in order to determine which gives the best results for a contained cost. </p><p> Clinical outcome was analysed using the modified Rankin Scale (mRS), in which patients are allocated a score that depends on the presence of neurological symptoms and an impaired capacity to perform daily-life activities. The indirect costs related to reduced productivity were calculated through the analysis of various indices: disabilityadjusted life years (DAYLs), years of life lost (YLL) and years lived with disability (YLD). </p><p> We calculated that a mRS score <2 obtained in 13.5% more of cases by using endovascular treatment in patients with occlusion of large vessels rather than venous fibrinolysis would lead to a saving of about 56 billion euros. Using data on the lifetime cost of a stroke, we calculated that a saving of about 11,400 billion euros could be achieved with endovascular treatment. </p><p> Clearly the savings are related to positive results that avoid indirect costs, in an ideal situation in which all patients are treated with endovascular methods. In any case, the analysis is a mathematical demonstration of the notable potential of this therapeutic technique.

Total Pages: 3-22 (20)

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