Summary. This paper presents a literature review of foreign and domestic sources on measurement of economic burden of brain vascular disorders that covers a wide range of issues, including medical and economic assessment and rationale for technologies and inpatient care delivery programs. Based on the literature data clinical and epidemiological situation associated with brain vascular disorders has been analyzed based on care applicability, mortality rates, hospital mortality, and primary disability of adult population. Cost of inpatient care for cerebral stroke has been estimated to show extremely high financial burden on health system, including inpatient care, medical and social rehabilitation and secondary prevention. Data on annual expenditures and structure of average cost per completed case of cerebral stroke, transient ischemic attack, and post-stroke vascular dementia that determine severity and length of hospital stay have been presented. The article rationalizes alignment of cost of treatment and care for patients at discharge with hospital mortality indicators as well as with assessment of neurological deficits and daily life activities with score scales for differentiated costing of health care. The document also demonstrates potential of evaluating care accessibility and quality within programs aimed at improving cerebral stroke register. Indicators of care efficiency have been defined: the level and length of hospital stay of patients with cerebral stroke at specialized neurological departments, access to neuroimaging and other modern high-tech diagnostic and treatment methods. The article has also analyzed program activities aimed at improving organization of inpatient care delivery to patients with stroke to meet target indicators of care quality and efficiency.

Keywords. Stroke; transient ischemic attack; vascular dementia; hospital mortality; hospital registers; inpatient care; quality; organizational accessibility.

References

1. Barashkov NS. Clinic and Economic Aspects of Acute Cerebrovascular Accident in Arterial Hypertension Patients. Cand.Sci.Med [thesis]. Ul'yanovsk; 2010. 25 p. (in Russian).
2. Bokeriya LA, Stupakov IN, Gudkova RG. Successes and Problems of Russian Cardiosurgery. Zdravookhranenie 2012;(3):24-33 (in Russian).
3. Vereshchagin N.V. Heterogeneity of Stroke in Clinic Practice. Nervnye bolezni 2004;(1):19– 20 (in Russian).
4. Dobzhanskiy NV, Vereshchagin NV, Metelkina LP, Protskiy SV, Shchipakin VL, Dzhibladze DN, et al. Reconstructive Surgery of Major Head Arteries with Cerebral Ischemia. In: Essays of Angioneurology. Suslina ZA, ed. Moscow: Atmosfera; 2005. 368 p. (in Russia).
5. Levin OS, Usol'tseva NI, Yunishchenko NA. Post-Stroke Cognitive Disorders: Mechanism of Development and Approaches to Treatment. Trudnyy patsient 2007;(8):29–34 (in Russian).
6. Rozhkova TI. Clinical and Epidemiological Analysis of Health Care Quality Provided to Stroke Patents in Various Regions of the Russian Federation (by the Data of Hospital Registration). Cand.Sci.Med [thesis]. Ul'yanovsk; 2011. 24 p. (in Russian).
7. Sekrieru EM, Moravskaya SV, Zakharova AB. Some Features of Formation of Hospital Morbidity Statistics by the Data of Federal Records. Sotsial'nye aspekty zdorov'ya naseleniya [serial online]. 2009 [cited 2012 Mar 15]; 11(3). Available from: http://vestnik.mednet.ru/content/view/130/30/lang,ru/
8. Suslina ZA, Varakin YuYa, Vereshchagin NV. Clinic and Epidemiological Researches as a Perspective Direction of Cerebral Pathology Study (the First Report). Annaly nevrologii 2009;(3): 4-11 (in Russian).
9. Suslina ZA, Tanashyan MM, Domashenko MA. Anti-Thrombotic Therapy of Ischemic Disorders of Cerebral Circulation from the Position of Evidence Based Medicine. 2 ed. Moscow: Meditsinskoe informatsionnoe agentstvo; 2009. 224 p. (in Russian).
10. Shtok VN. Qualification tests on neurology. Moscow: MEDpress; 2010. 208 p. (in Russian).
11. Brott TG. Carotid surgery to prevent stroke. Lancet Neurol 2004; 3: 452-453.
12. Dodel RC, Haacke C., Zamzow K., Pawelzik S., Spottke A., Rethfeldt M, et al. Resource Utilization and Costs of Stroke Unit Care in Germany. Value health 2004;2(7):144-152.
13. Epstein D, Mason A, Manca A. The hospital cost of care for stroke in nine European countries. Health Economics 2008 Jan; (17 Suppl. 1):S21–31.
14. Evers SM, Ament AJ, Blaauw G. Economic evaluation in stroke research: A systematic review. Stroke 2000 May;5(31):1046–1053.
15. Feidin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a rewiew of population-based-studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;(2):43-53.
16. Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N. Engl. J. Med 2008 Sep 25; 359 (13):1317– 29.
17. Knopman DS. Dementia and Cerebrovascular Disease. Mayo Clinic Proceedings 2006 Feb; 81(2):223–230.
18. Kwon S, Hartzema AG, Duncan PW, Min-Lai S. Disability Measures in Stroke: Relationship Among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke 2004;(35):918-923.
19. OECD (2011), Health at a Glance 2011: OECD Indicators, OECD Publishing. [Internet] 2011 [cited 2012 Mar 20]. Available from: http://dx.doi.org/10.1787/health_glance-2011-en
20. Sabín JÁ. In-Hospital Mortality in Stroke Patients. Rev. Esp. Cardiol 2008; 61(10):1007-1009.
21. Vega T, Zurriaga O, Mauro J, MilagrosGil R, Alamo R, Lozano J, et al. Stroke in Spain: Epidemiologic Incidence and Patterns; A Health Sentinel Network Study. Journal of Stroke and Cerebrovascular Diseases 2009 Jan-Feb;18(1):11-16.
22. Yekhlef F, Decup D, Niclot P, Servan J, Descombes S, Richecoeur J, et al. Medico-economic assessment of the Pontoise Hospital stroke unit. Revue Neurologique 2010 Nov;166(11):901–908.

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