[Organization and costs of stroke care in outpatient settings: Systematic review]

Aten Primaria. 2023 Mar;55(3):102578. doi: 10.1016/j.aprim.2023.102578. Epub 2023 Feb 9.
[Article in Spanish]

Abstract
in English, Spanish

Objective: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care.

Design: Systematic review.

Data sources: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012-12/31/2021 with descriptors included in Medical Subject Heading (MeSH).

Selection of studies: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded.

Data extraction: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected.

Results and conclusions: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.

Objetivo: Revisar la bibliografía sobre costes del ictus (ICD-10 código I63) en el ámbito de la atención primaria.

Diseño: Revisión sistemática.

Fuentes de datos: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit y Ovid/Embase entre el 1 de enero de 2012 y el 31 de diciembre de 2021 con descriptores incluidos en Medical Subject Heading (MeSH).

Selección de estudios: Aquellos con descripción de costes de actividades realizadas en el ámbito extrahospitalario. Se incluyeron revisiones sistemáticas; estudios observacionales prospectivos y retrospectivos; análisis de bases de datos y de costes totales o parciales del ictus como enfermedad (COI). Se agregaron artículos utilizando el método de «bola de nieve». Se excluyeron los estudios: a) no relacionados concretamente con el ictus; b) en formato de editoriales o comentarios; c) irrelevantes después de examinar el título y el resumen; d) literatura gris y estudios no académicos.

Extracción de datos: A los estudios se les asignó un nivel de evidencia según los niveles GRADE. Se recogieron datos de costes directos e indirectos.

Resultados y conclusiones: Treinta estudios, de los que 14 (46,6%) eran relativos a costes postictus y 12 (40%) a costes en prevención cardiovascular. Los resultados muestran que la mayoría son análisis retrospectivos de diferentes bases de datos de atención hospitalaria a corto plazo, y no permiten realizar un análisis detallado de los costes por diferentes segmentos de servicios. Las posibilidades de mejora aparecen centradas en la prevención primaria y secundaria, selección y traslado prehospitalario, el alta precoz con soporte y la atención sociosanitaria.

Keywords: Atención primaria; Costes; Costs; Ictus; Primary care; Stroke.

Publication types

  • Systematic Review
  • English Abstract

MeSH terms

  • Costs and Cost Analysis
  • Humans
  • Outpatients*
  • Prospective Studies
  • Retrospective Studies
  • Stroke* / therapy