title: International comparison of stroke cost studies.
abstract: OBJECTIVE
  With the rapid international spread of interventions, there is a need to understand the economic implications of these changes and to interpret these economic implications on the international level. The purpose of this study is to systematically compare total health care expenditures on stroke, the costs of stroke per capita, and the distribution of stroke costs within different countries, with special attention to the allocation of resources among different health care facilities.
  
  
  METHODS
  Studies for this literature review were selected by conducting a literature search from January 1966 to July 2003. Key methodological, country-related, and monetary issues of the selected stroke cost studies were evaluated using a checklist.
  
  
  RESULTS
  After selection, 25 stroke cost studies were reviewed. Although the selected cost of illness studies used different methodologies, the estimated expenditures for stroke are approximately similar. The proportion of national health care in the 8 countries studied is unequivocal for the more recent studies, ie, approximately 3% of total health care expenditures. A shift is observed from the inpatient treatment costs (in the first year) toward outpatient treatment and long-term care costs (in the latter years). Furthermore, it is remarkable that in the studies, little attention is paid to costs borne by the patient and family or to the costs of comorbidity.
  
  
  CONCLUSIONS
  This study highlights the importance of studying the economic consequences of stroke and of interpreting the results on the international level. The results of stroke cost studies provide insight into the distribution of the costs of stroke and the impact of stroke on the national expenditure on health care.
authors.affiliation: Care and Public Health Research Institute (CAPHRI) of Maastricht University, Maastricht University, Faculty of Health Sciences, Maastricht, The Netherlands. S.Evers@BEOZ.unimaas.nl
authors.forename: Silvia M A A
authors.initials: SM
authors.lastname: Evers
authors.forename: Jeroen N
authors.initials: JN
authors.lastname: Struijs
authors.forename: André J H A
authors.initials: AJ
authors.lastname: Ament
authors.forename: Marianne L L
authors.initials: ML
authors.lastname: van Genugten
authors.forename: J Hans C
authors.initials: JH
authors.lastname: Jager
authors.forename: Geertrudis A M
authors.initials: GA
authors.lastname: van den Bos
mesh_terms: D017281:Cost of Illness; D003431:Cross-Cultural Comparison; D014943:Global Health; D017048:Health Care Costs / Q000706:statistics & numerical data* / Q000639:trends; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends; D006268:Health Facilities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D020521:Stroke / Q000191:economics* / Q000453:epidemiology; D014481:United States / Q000453:epidemiology