In recent years, pharmacoeconomic studies have drawn increasing attention from experts in clinical medicine, pharmacy, health economics and health management. Their findings play an important role in drug pricing, drafting of the List of Essential Medicines and rational selection of clinical drugs. The essay summarizes the literatures published in recent years concerning pharmacoeconomics of traditional Chinese medicines on stroke, in order to make clear the current development of the latest studies on traditional Chinese medicines on treating stroke and rehabilitation methods and provide basis for further studies on pharmacoeconomics of traditional Chinese medicines on stroke and reference for rational clinical drug use.
Animals ; Antithrombins ; economics ; therapeutic use ; Drug Therapy ; economics ; Drugs, Chinese Herbal ; economics ; therapeutic use ; Economics, Pharmaceutical ; Humans ; Medicine, Chinese Traditional ; economics ; Stroke ; drug therapy ; economics

INTRODUCTIONThis study aimed to investigate the direct cost of outpatient care for patients with stroke, as well as the relationship between the aforementioned cost and the sociodemographic and stroke characteristics of the patients.

METHODSThis was a cross-sectional study involving patients with first-ever stroke who were attending outpatient stroke rehabilitation, and their family members. Participants were interviewed using a structured questionnaire designed to obtain information regarding the cost of outpatient care. Stroke severity was measured using the National Institute of Health Stroke Scale.

RESULTSThis study comprised 49 patients (28 men, 21 women) with a mean age of 60.2 (range 35-80) years. The mean total cost incurred was USD 547.10 (range USD 53.50-4,591.60), of which 36.6% was spent on attendant care, 25.5% on medical aids, 15.1% on travel expenses, 14.1% on medical fees and 8.5% on out-of-pocket expenses. Stroke severity, age > 70 years and haemorrhagic stroke were associated with increased cost. The mean cost of attending outpatient therapy per patient was USD 17.50 per session (range USD 6.60-30.60), with travelling expenses (41.8%) forming the bulk of the cost, followed by medical fees (38.1%) and out-of-pocket expenses (10.9%). Multiple regression analysis showed that stroke severity was the main determinant of post-stroke outpatient care cost (p < 0.001).

CONCLUSIONPost-stroke outpatient care costs are significantly influenced by stroke severity. The cost of attendant care was the main cost incurred during the first three months after hospital discharge, while travelling expenses was the main cost incurred when attending outpatient stroke rehabilitation therapy.

Adult ; Aged ; Aged, 80 and over ; Ambulatory Care ; economics ; Cross-Sectional Studies ; Female ; Health Care Costs ; Humans ; Malaysia ; Male ; Middle Aged ; Neurology ; economics ; Outpatients ; Rehabilitation ; economics ; Severity of Illness Index ; Social Class ; Stroke ; economics ; Stroke Rehabilitation ; Surveys and Questionnaires

OBJECTIVE1) To estimate annual direct medical costs of coronary heart disease (CHD) and stroke attributable to hypertension among Chinese adults aged 35-74 years in China, 2) to analyze the correlation between the hypertension awareness and hypertension treatment rate.

METHODS2003 National Health Services Survey (n = 93 018) was used to derive direct medical costs including costs for outpatient visits, physician services, inpatient stays, rehabilitation services, nurses fees, and medications. The medical costs of CHD and stroke attributable to hypertension were estimated by multiplying population attributable risk proportion by corresponding disease costs. Using 2002 National Nutrition and Health Survey (n = 148 804), the prevalence of hypertension awareness and hypertension treatment rate in 132 survey sites were calculated. Correlation was used to analyze the correlation between the two variables.

RESULTSThe direct medical costs of hypertension, CHD and stroke were 20.2, 15.7 and 24.3 billion Yuan, respectively. The medical costs attributable to hypertension were estimated at 19.1 billion Yuan (RMB), accounting for 47.7% of the total medical costs of the two chronic diseases. The prevalence of hypertension awareness is highly correlated with hypertension treatment rate (r = 0.9777, P < 0.0001).

CONCLUSIONThe economic burden of CHD and stroke attributable to hypertension is very high, reaching about 50% of the total medical costs of the two diseases. The prevalence of hypertension awareness could be used as an important indicator to evaluate the effectiveness of hypertension prevention and control at community level.

China ; Coronary Disease ; economics ; etiology ; Cost of Illness ; Data Collection ; Health Care Costs ; statistics & numerical data ; Humans ; Hypertension ; complications ; Stroke ; economics ; etiology

OBJECTIVETo evaluate the cost-effectiveness of combining Chinese medicine (CM) with Western medicine (WM) for ischemic stroke patients.

METHODSHospitalization summary reports between 2006 and 2010 from eight hospitals in Beijing were used to analyze the length of stay (LOS), cost per stay (CPS), and outcomes at discharge.

RESULTSAmong 12,009 patients (female, 36.44%; mean age, 69.98±13.06 years old), a substantial number of patients were treated by the WM_Chinese patent medicine (CPM)_Chinese herbal medicine (CHM) (38.90%); followed by the WM_CPM (32.55%), the WM (24.26%), and the WM_CHM (4.15%). With adjustment for confounding variables, LOS of the WM_CPM_CHM group was about 10 days longer than that of the WM group, and about 6 days longer than that of the WM_CPM group or the WM_CHM group (P<0.01); CPS of the WM_CPM_CHM group was United States dollar (USD) 1,288 more than that of the WM group, and about USD 600 more than that of the WM_CPM group or the WM_CHM group (P<0.01). Compared with the WM group, odd ratio (OR) of recovered and improved outcome of the WM_CPM_CHM group was the highest [OR: 12.76, 95% confidence intervals (CI): 9.23, 17.64, P<0.01], OR of death outcome of the WM_CPM_CHM group was the lowest (OR: 0.08, 95% CI: 0.05, 0.12, P<0.01). There was no significant difference between LOS, CPS and OR of the WM_CPM group and those of the WM_CHM group (P>0.05). Cost/effectiveness and incremental cost-effectiveness ratio of the WM_CPM_CHM group were robustly higher than those of the WM group.

CONCLUSIONCompared with WM alone, supplementing CPM and CHM to WM provides significant health benefits of improving the chance of recovered and improved outcome, and reducing the death rate, at an expense of longer LOS and higher CPS.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Ischemia ; complications ; drug therapy ; economics ; Child ; Child, Preschool ; Cost-Benefit Analysis ; Decision Trees ; Drug Therapy, Combination ; Female ; Hospitalization ; economics ; Humans ; Infant ; Infant, Newborn ; Length of Stay ; Linear Models ; Male ; Medicine, Chinese Traditional ; economics ; Middle Aged ; Patents as Topic ; Risk Factors ; Stroke ; complications ; drug therapy ; economics ; Treatment Outcome ; Young Adult

While communicable diseases still pose a serious health threat in developing countries, previously neglected health issues caused by non-communicable diseases such as stroke are rapidly becoming a major burden to these countries. In this review we will discuss the features and current status of stroke in low- and middle-income countries (LMICs). Overall the global burden of hemorrhagic stroke is larger than ischemic stroke, with a disproportionately greater burden, measured in incidence and disability-adjusted life-years, regionally localized in LMICs. Patients in poorer countries suffer due to insufficient primary care needed to control risk factors such as hypertension, and inadequate emergency care systems through which sudden events should be managed. In light of these situations, we emphasize two strategic points for development assistance. First, assistance should be provided for bolstering, integrating, and coordinating both the primary health and emergency care systems, in order to prevent stroke and strengthen stroke management, respectively. Second, the assistance needs to focus on programs at the community level, to reduce life-style risks of stroke in a more sustainable manner, and to improve stroke outcomes more effectively.
Delivery of Health Care/*organization & administration ; Developing Countries/*economics ; *Economic Development ; Global Health ; Health Promotion/*organization & administration ; Humans ; Incidence ; International Cooperation ; Models, Organizational ; Prevalence ; Risk Factors ; Stroke/economics/*epidemiology/*prevention & control

OBJECTIVETo analyze the direct economic burden of stroke in rural areas of Hanzhong.

METHODSPlan on primary interview was made after the purpose of the study had been informed to the managers of the 'surveillance field base', heads and members of the monitor assistants and detailed information was collected in the fields. Every single patient of stroke was then interviewed by the above said interviewers,using a self-designed questionnaire. 164 patients with stroke were interviewed in 53 villages with 75,000 persons lived there. The main items involved in the questionnaire would include: costs for inpatient or outpatient, reaching-out fees, fee for accommodation during treatment as outpatient, costs for treatment at home, long term medicine, caregivers and funerals as well as average income.

RESULTSThe median of annual direct economic burden was 3100 Yuan for each patient in Hanzhong rural area. There were no significant differences seen between males and females or among age groups (P > 0.05). The proportion of patients with medians of annual direct economic burden of: 1000 Yuan and below, 1001-5000 Yuan, 5001-10,000 Yuan, 10,001-20,000 Yuan and over 20,001 Yuan, were 29.2%, 36.0%, 18.3%, 9.8% and 6.0% respectively. The median of annual direct economic burden of first episode stroke was 5500 Yuan for each patient, and that of stroke was 1700 Yuan for each chronic patient. The direct economic burden of first episode was significantly higher than that of stroke (P < 0.01). The costs of hospitalization, accommodation of hospitalization and treatment at home of middle-aged patients were significant higher than that of old age patients (P < 0.05).

CONCLUSIONIn this study, the direct economic burden of stroke was 2.9 times of the annual personal average income, which was contrary to the reports from other countries. However, the State Health Bureau bore 87.1% of the direct economic burden for urban patients, but patients in the rural areas had to pay from their own pockets. The direct economic burden of stroke was heavy in Hanzhong rural region, which called for measures to be made to decrease the direct economic burden of stroke in the region.

Age Distribution ; Aged ; China ; Cost of Illness ; Female ; Humans ; Income ; statistics & numerical data ; Male ; Middle Aged ; Rural Population ; statistics & numerical data ; Sex Distribution ; Stroke ; economics

OBJECTIVES: To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective. METHODS: We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients' and caregivers' productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated. RESULTS: A total of 882,143 stroke patients were identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively. CONCLUSIONS: Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.
Adult ; Aged ; Aged, 80 and over ; Female ; *Health Care Costs ; *Health Expenditures ; Humans ; Insurance Claim Review ; Korea ; Male ; Middle Aged ; Prevalence ; Socioeconomic Factors ; Stroke/*economics ; Young Adult

OBJECTIVEUsing the indirect economic burden of stroke in a rural population to develop rational allocation of future health resources, in Hanzhong area.

METHODSCluster sampling which involved 53 natural villages with a total number of 75,000 people selected from the 'stroke monitoring base' of rural population was adopted in this study in the Hanzhong area. All of the 164 stroke cases were studied through a self-designed questionnaire. In calculating disability-adjusted life years (DALYs), fixed value was used in accordance with the value of GBD. The disability assessment was simplified in DALYs calculation and modified Barthel's ADL was used in disability assessment of stroke patients. In indirect economic burden analysis, the human capital method combined with DALYs was adopted with the formula as: indirect economic burden = GNP per capita x DALYs x productivity weight.

RESULTSThe total DALYs were 598.88, with an average DALY of stroke as 3.65 per case. The total indirect economic burden of stroke patients in rural areas was 1,993,977.8 RMB and the average of indirect economic burden of stroke was 12,158.4 RMB per case with the largest seen in the 45-59 age group, accounted for 74.4%.

CONCLUSIONIn our study, the use of method in combining the human capital with DALYs was the first time being adopted in calculation of the indirect economic burden of stroke in rural population in China. The burden seemed to be much lower than literature cited from other countries. It was reasonable to evaluate indirect economic burden of stroke using method in integrating DALYs with human capital, but it was difficult to calculate the DALYs.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; China ; Cost of Illness ; Female ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Quality-Adjusted Life Years ; Stroke ; economics ; epidemiology ; Young Adult