Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, December 3, 2014

Stroke Care Projected to Add Up to More Than Previously Thought

And if you are going to reduce that cost substantially you need to stop a lot of dead and damaged neurons from occurring. That requires stopping the neuronal cascade of death. But this focuses on the stupidity of staying with the appalling efficacy rate of 12% for tPA. They are not even addressing the right problem. So the direct costs in the US every year is approximately 500,000 * 140,048 = 70 billion. It doesn't quite meet the 214 billion for Alzheimers but still is substantial. And yet that is obviously not enough to spend a little money and hire some people to come up with a strategy to solve all the problems in stroke. The market will not solve this problem.
http://jama.jamanetwork.com/article.aspx?articleid=1983677
The long-term cost of treating stroke adds up to more than previous shorter-term estimates suggested, a recent study of Australian patients found.

Stroke experts say they expect the cost would be even higher in the United States than in Australia, highlighting the importance of early treatment and prevention.

The study in Australia is thought to be the first to look at the cost of care for 10 years after a stroke (Gloede TD et al. Stroke. 2014;45[11]:3389-3394). Researchers interviewed 286 patients who had a stroke and survived for at least a decade. Of that total, 243 had an ischemic stroke, while 43 had an intracerebral hemorrhage (ICH).

Previous research estimated lifetime costs in Australia using data from 5 years after a stroke (Cadilhac DA et al. Stroke. 2009;40:915-921). It suggested that costs peaked in the first year and then declined in the following years. But the new study found that the annual direct cost of care for a patient after an ischemic stroke was $5207 10 years out, only slightly lower than the annual cost between years 3 and 5, which was $5438. For patients who had an ICH, the annual cost at 10 years was $7607, considerably higher than the annual cost at 3 to 5 years, which was $5807. (Although the study was conducted in Australia, the costs were reported in US dollars.)

The authors of the Australian study estimated the lifetime costs of direct care at $68 769 for a patient after an ischemic stroke and $54 956 for a patient after an ICH. Those amounts are about 50% higher than lifetime estimates they had published previously based on 5-year data, which were $47 354 for ischemic stroke care and $39 628 for ICH care.

Even so, “the (Australian) numbers are considerably less than the current estimate of direct lifetime cost of ischemic stroke in the US,” which is $140 048, Larry Goldstein, MD, director of the Duke Stroke Center, said in an e-mail (Go AS et al. Circulation. 2014;129[3]:e28-e292).

“The way health care is delivered and priced may influence cost differences between the two health systems,” Dominique Cadilhac, PhD, MPH, senior author of the study of Australian patients, said in an e-mail. Australia has publicly funded universal health care, which coexists with private health care, said Cadilhac, who heads up the translational public health and evaluation division at the Monash University Stroke and Ageing Research Group in Melbourne.

“It is clear that overall, our system is more cost-effective, as the vast majority of stroke care is delivered under the public health system, which has a capitated budget and cost-control measures,” neurologist Christopher Levi, MD, director of the Stroke Research Program at the Hunter Medical Research Institute in Newcastle, Australia, said in an e-mail. Levi formerly served as medical director of Australia’s National Stroke Foundation.

Compared with Australia, “our skilled nursing facilities, our medication costs, our health care system—everything tends to cost more” in the United States, said Ralph Sacco, MD, MS, chairman of neurology at the University of Miami’s Miller School of Medicine.

In fact, across the board, the price of medications, medical technology, and other components of health care is about twice as much in the United States as in Australia, said Gerard Anderson, PhD, director of the Center for Hospital Finance and Management at the Johns Hopkins Bloomberg School of Public Health.

“All countries negotiate much more effectively for price than the United States does,” Anderson said. “We just pay a lot more for the same things.”

But price alone probably doesn’t explain the higher cost of stroke care in the United States, he said. “It’s certainly a reasonable hypothesis” that US stroke patients have more comorbidities that add to the cost of their care, he said. In addition, Anderson said, “we tend to use a little more technology and a little more expensive technology.”

The cost of care in the United States is not only more expensive item by item, but the country’s population is more heterogeneous than Australia’s, leading to greater overall costs for stroke care, said Bruce Ovbiagele, MD, co-chair of the neurosciences department at the Medical University of South Carolina.

Ovbiagele chaired an American Heart Association/American Stroke Association (AHA/ASA) committee that in 2013 published a policy statement forecasting the future of stroke in the United States (Ovbiagele B et al. Stroke. 2013;44[8]:2361-2375). The statement, coauthored by Goldstein and Sacco among others, projected that between 2012 and 2030, total direct medical costs for stroke in the United States will have nearly tripled, from $71.55 billion to $184.13 billion, with aging of the population and growth in per capita medical spending the primary drivers.

The AHA/ASA committee predicted that by 2030, 3.9% of US individuals older than 18 years will have had a stroke, with the greatest increases seen among white Hispanic men, followed by other races and ethnicities and black men and women. By comparison, a 2012 report prepared for Australia’s National Stroke Foundation projected that by 2032, 2.4% of that country’s population will have had a stroke (http://bit.ly/1wcXXcL).

“We are concerned that stroke is becoming increasingly costly as the population ages,” Sacco said. “One, we’re seeing more strokes, and two, people are living longer, which means there’s going to be greater costs. When people die, they don’t cost as much,” he said. In 2008, stroke dropped from third place—a spot it had held for 50 years—to fourth among the leading killers of people in the United States, according to the National Center for Health Statistics (http://1.usa.gov/1rB02Zt).

Sacco praised the Australian study for helping to fill in some of the many blanks about the cost of strokes. “They’re adding to the literature by giving us a 10-year estimate,” Sacco said. “People with stroke survive longer, so we need a better handle on what the full costs are for a stroke for longer periods.”

Indeed, the Australian study’s estimates of survival based on 10-year data are higher than those based on 5-year data. The researchers now estimate that, on average, 31% of patients who had an ischemic stroke and 27% of patients who had an ICH live for at least a decade after their stroke. Their earlier model, based on 5-year data, estimated that only 21% of both ischemic stroke and ICH patients survived 10 years.

Although ICH occurs less frequently than ischemic strokes, “they tend to be more severe,” with greater neurological deficits and disabilities, which helps explain the greater annual cost of their care and their lower survival rate, said Sacco, who was not involved in the study of Australian patients.

The increase seen in the cost of care over time for ICH “was mainly driven by a greater need for aged care (nursing home) services,” Cadilhac said. For patients who’ve had ischemic stroke, “nursing home utilization was more consistent” from 5 years to 10 years, first author Tristan Gloede said in an e-mail. Gloede is a PhD candidate at the University of Cologne’s Institute for Medical Sociology, Health Services Research, and Rehabilitation Science. A possible limitation of the study was the small number of patients who had an ICH, Gloede said. “In the future, we should replicate the study to see whether we will yield similar findings.”

After ischemic stroke, average annual medication costs were slightly greater at 10 years than at years 3 to 5, while inpatient rehabilitation costs were lower, Cadilhac’s team found. After ICH, the average annual cost of nursing home care was 64% greater at 10 years than at 3 to 5 years, while the average annual medication cost was 70% higher than the earlier years.

“A stroke survivor, even after 5 years, still requires a certain amount of care with medications, with placement, with rehabilitation, and these do become additive,” Sacco said. “It’s possible that the improved survival is driving up costs, but we do have cost-effective medications that can reduce costs.”

The problem, he said, is that tissue plasminogen activator (tPA), the only treatment approved by the US Food and Drug Administration for ischemic strokes, is greatly underused, Sacco said. If given within 4.5 hours of a stroke, tPA can dissolve a clot and improve blood flow in the brain, thereby minimizing the long-term effects of a stroke and preventing death.

But even in the parts of the United States that tend to provide the most aggressive stroke care, such as New York City, Houston, and Miami, only 10% to 15% of stroke patients are treated with tPA, Sacco said. The percentage of patients having an ischemic stroke who received tPA within 3 hours of onset did nearly double from 2003-2005 to 2010-2011, but the increase was only from 4% to 7% (Schwamm LH et al. Circ Cardiovasc Qual Outcomes. 2013;6[5]:543-549).

“It’s not the system. Now we have plenty of stroke centers,” Sacco said, referring to the more than 1000 US hospitals that have been certified as primary stroke centers by the AHA/ASA and the Joint Commission. “The majority of strokes don’t come in in time. That is the main reason tPA is not given.” Levi said the situation isn’t much different in Australia, where the national tPA rate is about 7%. “I don’t think there is any evidence that Australians access acute stroke care any earlier than others,” Levi said.

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