The costs associated with stroke care continuum : a systematic review

Stroke, a leading cause of death and long-term disability, has a considerable social and economic impact. It is impera‑ tive to investigate stroke-related costs. The main goal was to conduct a systematic literature review on the described costs associated with stroke care continuum to better understand the evolution of the economic burden and logistic challenges. This research used a systematic review method. We performed a search in PubMed/MEDLINE, ClinicalTrial. gov, Cochrane Reviews, and Google Scholar confned to publications from January 2012 to December 2021. Prices were adjusted using consumer price indices of the countries in the studies in the years the costs were incurred to 2021 Euros using the World Bank and purchasing power parity exchange rate in 2020 from the Organization for Economic Co-operation and Development with the XE Currency Data API. The inclusion criteria were all types of publications, including prospective cost studies, retrospective cost studies, database analyses, mathematical models, surveys, and cost-of-illness (COI) studies. Were excluded studies that (a) were not about stroke, (b) were editorials and commentaries, (c) were irrelevant after screening the title and abstract,(d) grey literature and non-academic studies, (e) reported cost indicators outside the scope of the review, (f ) economic evaluations (i.e., cost-efectiveness or cost- beneft analyses); and (g) studies not meeting the population inclusion criteria. There may be risk of bias because the efects are dependent on the persons delivering the intervention. The results were synthetized by PRISMA method. A total of 724 potential abstracts were identifed of which 25 articles were pulled for further investigation. The articles were classifed into the following categories: 1)stroke primary prevention, 2) expenditures related to acute stroke care, 3) expenditures for post-acute strokes, and 4) global average stroke cost. The measured expenditures varied consider‑ ably among these studies with a global average cost from €610-€220,822.45. Given the great variability in the costs in diferent studies, we can conclude that we need to defne a common system for assessing the costs of strokes. Possible limitations are related to clinical choices exposed to decision rules that trigger decisions alerts within stroke events in a clinical setting. This fowchart is based on the guidelines for acute ischemic stroke treatment but may not be applicable to all institutions.