Estimated societal costs of stroke in the UK based on a discrete event simulation

ABSTRACT Background there are around 100,000 new stroke cases and over a million people living with its consequences annually in the UK. This has large impacts on health and social care, unpaid carers and lost productivity. We aimed to estimate associated costs. Methods we estimated 2014/2015 annual mean cost per person and aggregate UK cost of stroke for individuals aged ≥40 from a societal perspective. Health and social care costs in the first and subsequent years after stroke were estimated from discrete event simulation modelling, with probability of progression and length of receipt of different health and social care services obtained from routine registry and audit data. Unpaid care hours and lost productivity were obtained from trial data. UK unit costs were applied to estimate mean costs. Epidemiological estimates of stroke incidence and prevalence were then applied to estimate aggregate costs for the UK. Results mean cost of new-onset stroke is £45,409 (95% CI 42,054-48,763) in the first year after stroke and £24,778 (20,234–29,322) in subsequent years. Aggregate societal cost of stroke is £26 billion per year, including £8.6 billion for NHS and social care. The largest component of total cost was unpaid care (61%) and, given high survival, £20.6 billion related to ongoing care. Conclusion the estimated aggregate cost of stroke substantially exceeds previous UK estimates. Since most of the cost is attributed to unpaid care, interventions aimed at rehabilitation and reducing new and recurrent stroke are likely to yield substantial benefits to carers and cost savings to society.

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The future incidence, prevalence and costs of stroke in the UK

Age and Ageing ◽

10.1093/ageing/afz163 ◽

2020 ◽

Vol 49 (2) ◽

pp. 277-282

Author(s):

Derek King ◽

Raphael Wittenberg ◽

Anita Patel ◽

Zahid Quayyum ◽

Vladislav Berdunov ◽

...

Keyword(s):

Social Care ◽

Stroke Care ◽

Population Projections ◽

Expert Consultation ◽

Public And Private ◽

Unpaid Care ◽

Lost Productivity ◽

The Uk ◽

Care Costs ◽

Constant Prices

Abstract Background we project incidence and prevalence of stroke in the UK and associated costs to society to 2035. We include future costs of health care, social care, unpaid care and lost productivity, drawing on recent estimates that there are almost 1 million people living with stroke and the current cost of their care is £26 billion. Methods we developed a model to produce projections, building on earlier work to estimate the costs of stroke care by age, gender and other characteristics. Our cell-based simulation model uses the 2014-based Office for National Statistics population projections; future trends in incidence and prevalence rates of stroke derived from an expert consultation exercise; and data from the Office for Budget Responsibility on expected future changes in productivity and average earnings. Results between 2015 and 2035, the number of strokes in the UK per year is projected to increase by 60% and the number of stroke survivors is projected to more than double. Under current patterns of care, the societal cost is projected to almost treble in constant prices over the period. The greatest increase is projected to be in social care costs—both public and private—which we anticipate will rise by as much as 250% between 2015 and 2035. Conclusion the costs of stroke care in the UK are expected to rise rapidly over the next two decades unless measures to prevent strokes and to reduce the disabling effects of strokes can be successfully developed and implemented.

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Cost-Effectiveness of Brivaracetam Versus Other Antiepileptic Drugs Used as Adjunctive Treatment for Focal Seizures in the Uk: A Discrete Event Simulation Model

Value in Health ◽

10.1016/j.jval.2016.09.111 ◽

2016 ◽

Vol 19 (7) ◽

pp. A365 ◽

Cited By ~ 2

Author(s):

M Charokopou ◽

J Sander ◽

R Saha ◽

S Beard ◽

R Kidd ◽

...

Keyword(s):

Cost Effectiveness ◽

Simulation Model ◽

Antiepileptic Drugs ◽

Discrete Event Simulation ◽

Discrete Event ◽

Adjunctive Treatment ◽

Event Simulation ◽

Discrete Event Simulation Model ◽

Focal Seizures ◽

The Uk

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Abstract 16: A Discrete Event Simulation to Assess the Impact of EMS Routing Algorithms on the Number Needed to Route and Transport Time

Stroke ◽

10.1161/str.48.suppl_1.16 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Brittany M Bogle ◽

Andrew W Asimos ◽

Wayne D Rosamond

Keyword(s):

Discrete Event Simulation ◽

Census Tract ◽

Discrete Event ◽

Routing Algorithms ◽

Screening Tools ◽

Transport Time ◽

Stroke Incidence ◽

Event Simulation ◽

Routing Policies ◽

The Impact

Introduction: Proposed EMS routing algorithms permit additional transport time to an endovascular center (EC) beyond the closest non-EC for patients with suspected large vessel occlusion acute ischemic stroke (LVO). The effectiveness of these algorithms depends on screening tools and patient location relative to EC and non-ECs. We implemented routing algorithms in a discrete event simulation to examine their impact on one region. Methods: We simulated stroke and stroke mimic patients screened by EMS over a year using hospital locations and demographics of Mecklenburg County, NC. We used an 8% LVO prevalence among those screened and geographically distributed patients using published stroke incidence rates and census tract population estimates, stratified by age, sex, and race. We estimated distance from census tract centroids to the nearest EC and non-EC using real road travel times. Last known well (LKW) was probabilistically assigned using county data. A patient was EC-routed if they screened positive, had LKW ≤6 hours and were within an allowable additional transport time. We simulated policies that varied by stroke severity screen (LAMS ≥ 4, RACE ≥ 5, C-STAT ≥ 2) and allowable additional transport time (10, 20, and 30 minutes). We define Number Needed to Route (NNR) as the number of patients enduring additional transport time to route one LVO patient to an EC. Results: Over 100 replications, EMS screened an average of 3102 patients annually; 249 were LVOs. NNRs were 2.6 (LAMS ≥ 4), 5.3 (RACE ≥ 5), and 9.3 (C-STAT ≥ 2). The number of EC-routed non-LVOs ranged from 87 (LAMS ≥ 4, 10 minutes) to 859 (C-STAT ≥ 2, 30 minutes). The proportion of LVOs within 10 and 20 minutes of added transport time to an EC was 67% and 99.6% respectively. EC-routing added a mean of 5.5 and 9.5 minutes to transport time for 10 and 20 minute policies respectively. A 20 minute policy EC-routed 1.8 times more patients than a 10 minute policy (e.g. C-STAT: 957 vs. 535). Increasing from a 20 to 30 minute policy routed only 4 more patients, thus these policies had similar results. Conclusions: We designed and tested a simulation tool to evaluate LVO routing policies. It is easily modifiable to aid in tailoring routing policies to a specific region. We propose using NNR as an intuitive metric of non-LVO overtriage.

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