title: A literature review of indirect costs associated with stroke.
abstract: BACKGROUND
  Stroke is a leading cause of mortality and long-term disability. However, the indirect costs of stroke, such as productivity loss and costs of informal care, have not been well studied. To better understand this, we conducted a literature review of the indirect costs of stroke.
  
  
  METHODS
  A literature search using PubMed, MEDLINE, and EconLit, with the key words stroke, cerebrovascular disease, subarachnoid hemorrhage, intracerebral hemorrhage, cost-of-illness, productivity loss, indirect cost, economic burden, and informal caregiving was conducted. We identified original research articles published during 1990-2012 in English-language peer-reviewed journals. We summarized indirect costs by study type, cost categories, and study settings.
  
  
  RESULTS
  We found 31 original research articles that investigated the indirect cost of stroke. Six of these investigated indirect costs only; the other 25 studies were cost-of-illness studies that included indirect costs as a component. Of the 31 articles, 6 examined indirect costs in the United States, with 2 of these focused solely on indirect costs. Because of diverse methods, kinds of data, and definitions of cost used in the studies, the literature indicated a very wide range internationally in the proportion of the total cost of stroke that is represented by indirect costs (from 3% to 71%).
  
  
  CONCLUSIONS
  Most of the literature indicates that indirect costs account for a significant portion of the economic burden of stroke, and there is a pressing need to develop proper approaches to analyze these costs and to make better use of relevant data sources for such studies or establish new ones.
authors: Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia. Electronic address: hjoo@cdc.gov.
authors: Heesoo
authors: H
authors: Joo
authors: Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors: Mary G
authors: MG
authors: George
authors: Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors: Jing
authors: J
authors: Fang
authors: Division for Heart Disease and Stroke Prevention, US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia.
authors: Guijing
authors: G
authors: Wang
mesh_terms: D017281:Cost of Illness; D003365:Costs and Cost Analysis; D017048:Health Care Costs; D006801:Humans; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000628:therapy
keywords: Stroke; cost of informal care; economic burden; indirect cost; productivity loss