چرا در یک برنامه ملی بهداشت عمومی برای سکته مغزی ، سرمایه گذاری می نماییم ؟ به عنوان مثال استفاده از داده های استرالیایی برای برآورد پیامدهای سود و زیان بالقوه

Objectives Stroke is the world's second leading cause of death in people aged over 60 years. Approximately 50,000 strokes occur annually in Australia with numbers predicted to increase by about one third over 10-years. Our objectives were to assess the economic implications of a public health program for stroke by: (1) predicting what potential health-gains and cost-offsets could be achieved; and (2) determining the net level of annual investment that would offer value-for-money. Methods Lifetime costs and outcomes were calculated for additional cases that would benefit if ‘current practice’ was feasibly improved, estimated for one indicative year using: (i) local epidemiological data, coverage rates and costs; and (ii) pooled effect sizes from systematic reviews. Interventions: blood pressure lowering; warfarin for atrial fibrillation; increased access to stroke units; intravenous thrombolysis and aspirin for ischemic events; and carotid endarterectomy. Value-for-money threshold: AUD$30,000/DALY recovered. Results Improved, prevention and management could prevent about 27,000 (38%) strokes in 2015. In present terms (2004), about 85,000 DALYs and AUD$1.06 billion in lifetime cost-offsets could be recovered. The net level of annual warranted investment was AUD$3.63 billion. Conclusions Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted.

Detailed data concerning the cost and burden of stroke in Australia are available, allowing extrapolation to future predicted populations to assess the effects of demographic changes with or without changes to important risk factors or management. Our intention was not to conduct a detailed economic evaluation of strokesafe™ over a phased implementation period. Rather, our objective was to estimate the likely impact of strokesafe™ in one representative year of full, but feasible implementation (i.e. ‘steady-state’ operation). The representative year was 2015, as this is the first year that ‘steady-state’ operation is likely to be achieved. A similar approach has been used recently to assess of the economic burden of stroke in England

Primary prevention, in particular blood pressure lowering, was most effective. A public health program for stroke is warranted.