US cost burden of ischemic stroke: A systematic literature review

Background: Stroke is an expensive disease from a patient, caregiver, and societal perspective. In spite of the high cost burden, only limited numbers of recent studies have focused on stroke-related costs in the United States. Objective: To conduct a systematic literature review to determine current US costs of stroke and to assess if a gap in available information exists. Methods: A literature search was conducted using the PubMed/MEDLINE and Ovid/EMBASE databases, within the date range of January 1995 to July 2008. The search, screening, application of eligibility criteria, appraisal, data extraction, and synthesis were completed by one investigator and then independently confirmed by a second. Results: The literature review revealed that the majority of cost-related analyses focused on short-term in-hospital care and early critical care as the key drivers of acute ischemic stroke hospitalization costs. Moreover, long-term medical expenses resulting from nursing home and ambulatory care as well as indirect expenditure from lost earnings and informal care represent the most significant burden on lifetime costs of stroke. Conclusions: Further studies that focus on these long-term and indirect expenditures are essential to assess the impact of new treatments on total stroke costs. Overall, the high costs associated with stroke clearly indicate there is an imperative need for effective preventive therapy, early critical care, and rehabilitation, which in turn will reduce the national expenditure for stroke-related healthcare services and improve productivity.