scholarly journals Cost of Illness Analysis and Quality of Life in Ischemic Stroke Patients In Usu Medan Hospital

2020 ◽  
Vol 8 (2) ◽  
pp. 1-6
Author(s):  
Darma Ericson Saragih ◽  
Azizah Nasution ◽  
Khairunnisa K
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Average Cost ◽  
Stroke Patients ◽  
Cost Rate ◽  
The Difference ◽  
Average Cost Rate ◽  
The Cost ◽  
Total Average Cost

Objective: aims to evaluate the COI INA-CBG BPJS patients hospitalized for ischemic stroke BPJS (n = 33) at USU Medan Hospital in February 2019-August 2019 period. Design: this study was conducted used a prospective cohort study method in patients with ischemic stroke (n = 33) in USU Hospital. Interventions: the intervened  variable were the cost of patient therapy and calculating the difference in claims of INA-CBGs with the cost of patient therapy. Main outcome measures: the main measurement in this study was quality of life with European Quality of Life - 5 Dimensions Three Level (EQ5D3L). Results:  the results of this study indicate the total average cost of ischemic stroke inpatient therapy at the In patient Installation of USU Hospital in Medan obtained Rp 2,284,854 The average cost / rate incurred by the Hospital for ischemic stroke patients (n = 33) is still below the INA-CBGs claim rate. There was a relationship between the quality of life of ischemic stroke patients with diagnosis and comorbidities of patients (p = 0.004). The average quality of life (QoL) of ischemic stroke patients was obtained 0.7324 ± 0.2118. Conclusion: it could be concluded that the quality of life of ischemic stroke patients is classified as good 32 patients (96.96%).    

Abstract WMP7: Cost Effectiveness of Stent-retriever Thrombectomy Compared With Intravenous Thrombolytic Therapy Alone in Acute Ischemic Stroke Patients

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Saqib A Chaudhry ◽  
Muhammad F Ishfaq ◽  
Kamesh Sivagnanam ◽  
Adnan I Qureshi
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Combination Therapy ◽  
Acute Ischemic Stroke ◽  
Stent Retriever ◽  
Stroke Patients ◽  
The Cost ◽  
Iv Tpa

Introduction: Despite recent clinical trials demonstrating greater benefit with mechanical thrombectomy,thehigher cost associated with thrombectomy may limit its broad applicability. Objective: To determine the cost-effectiveness of stent-retriever thrombectomy plus IV-tPA versus IV-tPA alone in acute ischemic stroke patients. Method: The probability of individual primaryendpoints was obtained from the results of the SWIFT PRIME trial that compared98 acute ischemic stroke patients who received intravenous rt-PA alone with 98 patients who had mechanical thrombectomy with IV rt-PA (combination therapy). Total cost associated with each therapeutic intervention was derived from hospitalization cost and cost associated with primary and secondary endpoints of dependence, independence and death in each group. All probabilities, quality-of-life factors, and costs were estimated from the published literature. Costs were adjusted for inflation. A Monte Carlo simulation model was built to compare the health benefits and costs associated with combination therapy compared with IV-tPA alone. Overall costs and QALY’s were varied around probability values from the SWIFT PRIME trial to generate the simulation. Standard errors were used for generating variability.Incremental cost effectiveness ratio and cost effectiveness acceptability curves were also derived. Results: The cost effectiveness acceptability plane was completely situated in the south-east quadrant. This denotes that thrombectomy along with t-PA was both cheaper as well as improved Quality of life when compared to t-PA alone. Overall, QALYs for the thrombectomy and Iv-tPA and IV-tPA groups were 0.60(0.005) and 0.51(0.004), respectively (ranging from 0.0 [death] to 0.77 [independent]. Overall cost of combination therapy was $754,790 (12,303) and for IV-tPA alone was $933,190($7,495). The incremental cost effectiveness ratio was -$21,450 ($1,857)per QALY. The major costs in the tPA arm were a result of greater dependence at 90 days. Conclusion: In acute ischemic stroke patients and major arterial occlusion, stent-retriever thrombectomy in addition to intravenous t-PA,is both cost effective and improves quality of life.

scholarly journals Comparison of 3-Month Stroke Disability and Quality of Life across Modified Rankin Scale Categories

2016 ◽  
Vol 6 (1-2) ◽  
pp. 36-41 ◽  
Author(s):  
Srikant Rangaraju ◽  
Diogo Haussen ◽  
Raul G. Nogueira ◽  
Fadi Nahab ◽  
Michael Frankel
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Functional Disability ◽  
Modified Rankin Scale ◽  
Stroke Patients ◽  
Good Outcome ◽  
Health Related Qol ◽  
Health Related ◽  
Sparse Methods

Background and Purpose: Modified Rankin Scale (mRS) score 0-2 has been used to define “good outcome” while stroke patients with mRS 3 are grouped with mRS 4-6 as having “poor outcome.” Long-term data comparing quality of life (QoL), particularly across the mRS 2, 3, and 4 subgroups, are sparse. Methods: Participants in the Interventional Management of Stroke 3 (IMS3) trial with documented 3-month mRS, functional disability (Barthel index [BI]), and self-reported EQ5D-3L QoL questionnaires at 3 months after stroke were included. EQ5D-3L summary indices were calculated using published utility weights for the US population. BI and EQ5D-3L indices were compared across mRS categories using multiple pairwise comparisons with appropriate alpha error corrections. Results: Four hundred twenty-three patients were included (mean age 64 ± 13 years, median baseline NIHSS 16 [IQR 12-19], mean BI 84.1 ± 25.3, and mean EQ5D-3L index 0.73 ± 0.24). While significant differences in BI were observed across mRS categories, QoL in the mRS 2 and 3 categories was similar. Based on BI and EQ5D-3L index, mRS 3 status was more similar to mRS 2 than to mRS 4 status, and large heterogeneity in the mRS 3 group was observed. Conclusions: Ischemic stroke patients who achieve mRS 2 and 3 functional outcomes seem to have similar health-related QoL scores. mRS 0-3, rather than 0-2, should be considered a good outcome category in moderate to severe ischemic stroke.

scholarly journals Efficacy of sovateltide (IRL-1620) in a multicenter randomized controlled clinical trial in patients with acute cerebral ischemic stroke

2020 ◽  
Author(s):  
Anil Gulati ◽  
Nilesh Agrawal ◽  
Deepti Vibha ◽  
U.K. Misra ◽  
Birinder Paul ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Odds Ratio ◽  
Controlled Study ◽  
Stroke Patients ◽  
Neurological Outcomes ◽  
Number Of Patients ◽  
Cerebral Ischemic Stroke ◽  
Cerebral Ischemic

Background: Sovateltide (IRL-1620, PMZ-1620), an endothelin-B receptor agonist, administered intravenously following acute cerebral ischemic stroke increased cerebral blood flow, had anti-apoptotic activity and produced neurovascular remodeling. Its safety and tolerability were confirmed in healthy human volunteers (CTRI/2016/11/007509). Objective: To determine safety, tolerability and efficacy of sovateltide as an adjuvant to standard of care (SOC) in acute cerebral ischemic stroke patients. Methods: A prospective, multi-centric, randomized, double-blind, controlled study to compare efficacy of sovateltide in patients with acute cerebral ischemic stroke was conducted in 40 patients, of which 36 completed 90-day follow-up. Patients who had stroke within the last 24 hours with a radiologic confirmation of ischemic stroke were included in the study. Patients with intracranial hemorrhage and those receiving endovascular therapy were excluded. All patients in both groups received SOC for stroke. Patients randomized in the sovateltide group received three doses of sovateltide (each dose 0.3 μg/kg) administered as an IV bolus over 1 minute at an interval of 3 hours ± 1 hour on day 1, day 3 and day 6 (total dose of 0.9 μg/kg/day). Patients randomized in the placebo group received equal volume of saline. Efficacy was evaluated by neurological outcomes based on National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) scales. Quality of Life was measured by EuroQoL (EQ-5D) and stroke specific quality-of-life (SS-QoL). Results: Patients received saline (n=18; 11 male and 7 female) or sovateltide (n=18; 15 male and 3 female) within 24 hours of onset of stroke. Number of patients receiving investigational drug within 20 hours of onset of stroke were 14/18 in saline and 10/18 in sovateltide cohorts. The baseline characteristics and SOC in both cohorts was similar. Sovateltide treatment resulted in a significantly quicker recovery as measured by improvements in neurological outcomes in mRS and BI scales on day 6 compared to day 1 (p<0.0001). Moreover, sovateltide increased the frequency of favorable outcomes in all scales at 3 months. An improvement of ≥2 points in mRS was observed in 60% and 40% patients in sovateltide and saline groups, respectively (p=0.0519; odds ratio 5.25). BI improvement of ≥40 points was 64% and 36% in sovateltide and saline groups, respectively (p=0.0112; odds ratio 12.44). An improvement of ≥6 points was seen in NIHSS in 56% of patients in sovateltide vs 43% in saline groups (p=0.2714; odds ratio 2.275). Number of patients with complete recovery achieving NIHSS score of 0 and BI of 100 were significantly more (p<0.05) in sovateltide group compared to saline group. Sovateltide treatment resulted in improved Quality of Life as measured by EuroQoL and SS-QoL (stroke specific quality-of-life) on day 90. Sovateltide was well tolerated and all patients received complete treatment with no incidence of drug related adverse event reported. Hemodynamic, biochemical or hematological parameters were not affected with sovateltide. Conclusion: Sovateltide was safe, well tolerated, and resulted in quicker recovery and improved neurological outcome in acute cerebral ischemic stroke patients 90 days post-treatment.

Abstract 210: Is Endovascular Treatment Beneficial in Acute Ischemic Stroke Patients With M2 Segment Middle Cerebral Artery Occlusion?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Adnan I Qureshi ◽  
Muhammad A Saleem
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Middle Cerebral Artery ◽  
Acute Ischemic Stroke ◽  
Cerebral Artery ◽  
Functional Independence ◽  
Neurological Deterioration ◽  
Stroke Patients

Background: The benefit of endovascular treatment in acute ischemic stroke patients with occlusion of distal middle cerebral artery (M2 segment) is unclear. Methods: We analyzed data from subjects with occlusion of M2 segment of middle cerebral artery confirmed with computed tomographic (CT) angiogram who were randomized to either intravenous (IV) recombinant tissue plasminogen activator (rt-PA) alone or in combination with endovascular treatment. We compared the rates of neurological deterioration within 24 hours; symptomatic intracranial hemorrhage (ICH) within 30 hours; good quality of life (defined by EQ-5D index score of ≥0.6) and functional independence (defined by modified Rankin scale of 0-2) at 3 months among subjects who underwent endovascular treatment with subjects who received IV rt-PA alone. Results: Of these 51 subjects (mean age ±SD; 68.3±11.8 years) with M2 segment occlusion, 34 and 17 subjects received IV rt-PA followed by endovascular treatment and IV rt-PA alone, respectively. There was a non-significantly lower rate of neurological deterioration (14.7% versus 25.0%) and symptomatic intracranial hemorrhages (5.9% versus 17.6%) among subjects who received IV rt-PA followed by endovascular treatment. At 3 months, the rates of independent functional outcome (52.9% versus 41.2%, odds ratio [OR] 1.6; 95 % confidence interval [CI] 0.5-5.2; P = 0.46) and good quality of life (50.0% vs 35.3% OR 1.9; 95% CI 0.5-7.2; p=0.37) were non-significantly higher among subjects with M2 segment occlusion who received IV rt-PA followed by endovascular treatment. The rate of death within 3 months was significantly lower among those who received IV rt-PA followed by endovascular treatment (5.9% vs 35.3%; OR 0.2; 95% CI 0.1-0.9; p=0.048). Conclusions: A randomized clinical trial should be considered based on the significant reduction in mortality and non-significant increase in functional independence and good quality of life following endovascular treatment in among acute ischemic stroke patients with M2 segment occlusion.

Availability and cost assessment of systems with dormant failure undergoing sequential inspections

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Himani Pant ◽  
S.B. Singh
Keyword(s):  
Average Cost ◽  
Inspection Time ◽  
Failed State ◽  
Content Type ◽  
Cost Rate ◽  
Long Run ◽  
Inspection Policy ◽  
Average Cost Rate ◽  
The Cost ◽  
Random Times

PurposeThe system encountering dormant failure subject to sequential inspections is modeled and the emphasis is made on determining the availability and long-run average cost rate for the model. The derived results are then utilized to obtain the optimal inspection period minimizing the cost.Design/methodology/approachExplicitly, a system with a functional and a failed state is taken into account. Inspections are performed to reveal the dormant failures and are assumed to be carried out at time T, T + aT, T + aT+a2 T, … where 0 < a = 1 in each cycle. Perfect repairs taking random times are performed if the system is found in a failed state during any inspection.FindingsSome theorems on the point availability, limiting availability and long-run average cost rate are obtained in the study. An illustration is shown to explain the results obtained in the proposed work. The effect of inspection time on the availability and cost rate is also analyzed graphically.Originality/valueThe availability and cost rate for a system with dormant failure under a sequential inspection policy are figured out unlike previous research.

scholarly journals COST EVALUATION OF STROKE THERAPY COMPARED TO INA-CBGs ON INPATIENTS AT ANUTAPURA HOSPITAL

2021 ◽  
Vol 16 (2) ◽  
pp. 285
Author(s):  
Muhamad Rinaldhi Tandah ◽  
Alwiyah Mukaddas ◽  
Dewi Angriani ◽  
Gaby Nathania Angela Mangoting
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Cost Evaluation ◽  
Stroke Therapy ◽  
Stroke Patients ◽  
Total Cost ◽  
Real Cost ◽  
Significant Difference ◽  
The Difference ◽  
The Cost

ABSTRACTStroke is the third cause of death in the world after heart disease, cancer, and disability including disability categorized based on its severity: mild (I), moderate (II), and severe (III) severity. This study aims to determine the difference total cost of ischemic and hemorrhagic stroke therapy, each, with INA-CBGs rates. The method of data collection was conducted retrospectively taken from medical record data, and on patient medical expenses. The subject were ischemic and hemorrhagic stroke patients hospitalized from 2016-2017 at Anutapura Hospital who met the inclusion and exclusion criteria. There were 134 patients who met the inclusion criteria, 68% were ischemic stroke patients and 32% were hemorrhagic stroke patients. The result of research showed that there were significant differences in costs (p <0.05) between hospital real costs and INA-CBGs rates. The average total real cost of treatment for ischemic stroke therapy was IDR 7,360,196.70 and the cost of the INA-CBGs was IDR 7,427,251.65 for 91 inpatients; and the average total cost of patients with hemorrhagic stroke therapy took IDR 10,606,834.34 with average of INA CBG’s rate at IDR 4,399,393.02 for 43 inpatients. The conclusion is both of stroke therapy proved significant difference compared to BPJS claimed amount of money.Keywords: pharmacoeconomic, cost analysis, ischemic stroke, haemorrhage stroke, INA-CBG’s rate.

scholarly journals Fatigue Impact Scale Demonstrates Greater Fatigue in Younger Stroke Survivors

2012 ◽  
Vol 39 (5) ◽  
pp. 619-625 ◽  
Author(s):  
Natalie E. Parks ◽  
Gail A. Eskes ◽  
Gordon J. Gubitz ◽  
Yvette Reidy ◽  
Christine Christian ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Younger Patients ◽  
Post Stroke ◽  
Impact Scale ◽  
Fatigue Impact Scale ◽  
One Year

Background:Fatigue affects 33-77% of stroke survivors. There is no consensus concerning risk factors for fatigue post-stroke, perhaps reflecting the multifaceted nature of fatigue. We characterized post-stroke fatigue using the Fatigue Impact Scale (FIS), a validated questionnaire capturing physical, cognitive, and psychosocial aspects of fatigue.Methods:The Stroke Outcomes Study (SOS) prospectively enrolled ischemic stroke patients from 2001-2002. Measures collected included basic demographics, pre-morbid function (Oxford Handicap Scale, OHS), stroke severity (Stroke Severity Scale, SSS), stroke subtype (Oxfordshire Community Stroke Project Classification, OCSP), and discharge function (OHS; Barthel Index, BI). An interview was performed at 12 months evaluating function (BI; Modified Rankin Score, mRS), quality of life (Reintegration into Normal living Scale, RNL), depression (Geriatric Depression Scale, GDS), and fatigue (FIS).Results:We enrolled 522 ischemic stroke patients and 228 (57.6%) survivors completed one-year follow-up. In total, 36.8% endorsed fatigue (59.5% rated one of worst post-stroke symptoms). Linear regression demonstrated younger age was associated with increased fatigue frequency (β=-0.20;p=0.01), duration (β=-0.22;p<0.01), and disability (β=-0.24;p<0.01). Younger patients were more likely to describe fatigue as one of the worst symptoms post-stroke (β=-0.24;p=0.001). Younger patients experienced greater impact on cognitive (β=-0.27;p<0.05) and psychosocial (β=-0.27;p<0.05) function due to fatigue. Fatigue was correlated with depressive symptoms and diminished quality of life. Fatigue occurred without depression as 49.0% of respondents with fatigue as one of their worst symptoms did not have an elevated GDS.Conclusions:Age was the only consistent predictor of fatigue severity at one year. Younger participants experienced increased cognitive and psychosocial fatigue.

Once-Daily Oral Deferasirox (Exjade®, ICL670) Versus Infusional Deferoxamine as Iron Chelation Therapy in Patients with Sickle-Cell Disease Receiving Frequent Transfusions: A Cost-Effectiveness Analysis.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5584-5584 ◽  
Author(s):  
Thomas E. Delea ◽  
Simu K. Thomas ◽  
Jean-Francois Baladi ◽  
Thomas D. Coates
Keyword(s):  
Quality Of Life ◽  
Chelation Therapy ◽  
Iron Chelation ◽  
Iron Chelator ◽  
Cell Disease ◽  
Once Daily ◽  
The Difference ◽  
One Year ◽  
The Cost

Abstract Background. Patients with sickle-cell disease (SCD) receiving chronic transfusions require chelation therapy to prevent complications from iron overload. Although deferoxamine (DFO) is an effective iron chelator, it must be administered as an 8–12 hour infusion 5–7 times per week, leading to poor compliance and/or reduced quality of life. Deferasirox (DSX) is an investigational once-daily oral iron chelator that has been shown to produce reductions in liver iron concentrations and serum ferritin similar in magnitude to those obtained with DFO. Cost-effectiveness (CE) analysis is a technique used to determine whether the benefits of new therapies are worth their additional costs. The objective of this analysis was to evaluate from a US perspective the CE of DSX versus DFO in SCD patients receiving frequent transfusions. Methods. Data from a variety of published and unpublished sources were used to estimate the CE of chelation therapy with DSX versus DFO in SCD patients receiving frequent transfusions (≥8 per year). As there are no long-term studies describing the complications of iron overload in patients with SCD, we focused on the short term (i.e., one year) costs and quality-of-life effects of chelation therapy. We assumed that patients would receive dosages (mg/kg/d) of DSX and DFO that have been found to be similarly effective in patients with SCD. To be conservative we assumed that all patients would be fully compliant with chelation therapy. CE was measured in terms of the ratio of the difference (DSX vs DFO) in costs to the difference in quality adjusted life years (QALYs) over one year of treatment. Analyses were based on the wholesale acquisition cost of generic DFO and the anticipated cost of DSX in the US. Mean weight was estimated to be 52 kg, based on data from deferasirox clinical studies. The cost of DFO administration was based on analyses of health insurance claims data for patients with transfusion-dependent anemias. Utilities (weights representing patient quality of life) were based on results of a study that used time-trade-off methods to estimate community-based preferences for oral versus infusional iron chelation therapy. Results. Total annual costs were estimated to be $1,486 greater with DSX ($22,922 vs $21,436 with DFO). Annual costs of DFO included $13,628 for drug acquisition and $7,808 for drug administration. One year of treatment with DSX is estimated to result in a gain of 0.25 QALYs (0.82 vs 0.57 with DFO). The CE of DSX versus DFO is therefore estimated to be $5,944 per QALY gained. CE of DSX versus DFO was sensitive to the assumed dosages of DSX and DFO and the cost of infusional therapy. Conclusion. In patients with SCD receiving frequent transfusions, DSX versus DFO is highly cost-effective compared with other generally-accepted treatments for patients with hematologic and oncologic disorders. These results may understate the CE of DSX, as they did not consider the potential benefits of improved compliance or side effects of infusion therapy. Further research is needed to assess the potential implication of DSX on the risk-benefit profile of transfusion therapy in patients with SCD.

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