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      High Total Hospitalization Cost but Low Cost of Imaging Studies in Recurrent Acute Ischemic Stroke Patients

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      1 , 2 , 3 , *
      PLoS ONE
      Public Library of Science

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          Abstract

          Background

          Due to the high risk and severity of recurrence after stroke attack, recurrence is a major reason contributing to the disease burden. This study aims to determine whether recurrence is a significant contributor of hospitalization cost in items for ischemic stroke patients.

          Methods

          This study assessed acute ischemic stroke patients admitted to an academic medical center in 2003 through 2009. The t-test and Chi-square tests were used to compare first-ever and recurrent ischemic stroke groups in terms of total and categorized hospitalization cost, and multiple regression was performed to assess the influence of stroke recurrence.

          Results

          Recurrent ischemic strokes were associated with higher total cost, but examination cost showed no difference between the two groups. The recurrent stroke group showed higher laboratory but lower imaging cost. Of imaging studies, there was no significant difference in computed tomography scan cost while the first-ever stroke group spent more on magnetic resonance imaging and sonography. Controlling for other influential factors, recurrence was discovered to be a significant factor in lowering examination cost.

          Conclusions

          The findings of stroke recurrence in lowering examination cost could be explained from two perspectives, different clinical patterns of healthcare utilization and patients' economic status in recurrent stroke.

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          Most cited references18

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          Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis.

          Estimates of risk of stroke recurrence are widely variable and focused on the short- term. A systematic review and meta-analysis was conducted to estimate the pooled cumulative risk of stroke recurrence. Studies reporting cumulative risk of recurrence after first-ever stroke were identified using electronic databases and by manually searching relevant journals and conference abstracts. Overall cumulative risks of stroke recurrence at 30 days and 1, 5, and 10 years after first stroke were calculated, and analyses for heterogeneity were conducted. A Weibull model was fitted to the risk of stroke recurrence of the individual studies and pooled estimates were calculated with 95% CI. Sixteen studies were identified, of which 13 studies reported cumulative risk of stroke recurrence in 9115 survivors. The pooled cumulative risk was 3.1% (95% CI, 1.7-4.4) at 30 days, 11.1% (95% CI, 9.0-13.3) at 1 year, 26.4% (95% CI, 20.1-32.8) at 5 years, and 39.2% (95% CI, 27.2-51.2) at 10 years after initial stroke. Substantial heterogeneity was found at all time points. This study also demonstrates a temporal reduction in 5-year risk of stroke recurrence from 32% to 16.2% across the studies. The cumulative risk of recurrence varies greatly up to 10 years. This may be explained by differences in case mix and changes in secondary prevention over time However, methodological differences are likely to play an important role and consensus on definitions would improve future comparability of estimates and characterization of groups of stroke survivors at increased risk of recurrence.
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            Epidemiology of stroke.

            R Bonita (1992)
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              Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project.

              There have been few community-based studies of long-term prognosis after acute stroke. This study aims to provide precise estimates of the absolute and relative risks of stroke recurrence in an unselected cohort of patients with a first-ever stroke. Six hundred seventy-five patients were registered in a community-based stroke register (the Oxfordshire Community Stroke Project) and prospectively followed for up to 6.5 years. Their relative risk of recurrent stroke was calculated using age- and sex-specific incidence rates for first stroke in Oxfordshire. One hundred eighty recurrent episodes of stroke were identified, of which 135 were first recurrences. Given survival, the actuarial risk of suffering a recurrence was 30% (95% confidence interval, 20% to 39%) by 5 years, about nine times the risk of stroke in the general population. The risk was highest early after the first stroke: 13% (95% confidence interval, 10% to 16%) by 1 year, 15 times the risk in the general population. After the first year the average annual risk was about 4%. The risk of stroke recurrence did not appear to be related to age or pathological type of stroke. The absolute and relative risks of recurrent stroke are highest early after the first stroke but remain elevated for several years thereafter. Efforts at secondary prevention should be initiated as soon as possible and continued for several years to gain greatest benefit.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                21 July 2014
                : 9
                : 7
                : e101360
                Affiliations
                [1 ]Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, Catholic University of Korea, Seoul, Korea
                [2 ]Department of Neurology, Kyung Hee University College of Medicine, Seoul, Korea
                [3 ]Department of Health Services Management, Kyung Hee University School of Management, Seoul, Korea
                University Of São Paulo, Brazil
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: YDK SSY HC. Performed the experiments: SSY. Analyzed the data: HC. Contributed reagents/materials/analysis tools: SSY HC. Wrote the paper: YDK HC.

                Article
                PONE-D-14-02894
                10.1371/journal.pone.0101360
                4105624
                25047140
                c406ebca-4359-4f23-91e6-110747e3130f
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 20 January 2014
                : 5 June 2014
                Page count
                Pages: 7
                Funding
                This study was supported by a Faculty Research Grant from the Kyung Hee University in 2009 (KHU-2009554). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Epidemiology
                Economic Epidemiology
                Health Care
                Socioeconomic Aspects of Health
                Neurology
                Cerebrovascular Diseases
                Public and Occupational Health
                Preventive Medicine
                Vascular Medicine
                Stroke
                Ischemic Stroke

                Uncategorized
                Uncategorized

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