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Understanding the relationship between costs and the modified Rankin Scale: a systematic review, multidisciplinary consensus and recommendations for future studies

Wilson, Alastair; Bath, Philip M.W.; Berge, Eivind; Cadilhac, Dominique A.; Cuche, Matthieu; Ford, Gary A.; Macisaac, Rachael; Quinn, Terence J.; Taylor, Matthew; Walters, Matthew; Wolff, Claudia; Lees, Kennedy R.

Authors

Alastair Wilson

Philip M.W. Bath

Eivind Berge

Dominique A. Cadilhac

Matthieu Cuche

Gary A. Ford

Rachael Macisaac

Terence J. Quinn

Matthew Taylor

Matthew Walters

Claudia Wolff

Kennedy R. Lees



Abstract

Background and purpose: Cost-of-illness studies often describe a single aggregate cost of a disease state. This approach is less helpful for a condition with a spectrum of outcomes like stroke. The modified Rankin Scale is the most commonly used outcome measure for stroke. We sought to describe the existing evidence on the costs of stroke according to individual modified Rankin Scale categories. This may be useful in future cost effectiveness modelling studies of interventions where cost data have not been collected, but disability outcome is known.
Methods: Systematic review of the published literature, searching electronic databases between 2004 and 2015 using validated search filters. Results were screened to identify studies presenting costs by individual modified Rankin Scale categories.
Results: Of 17,782 unique identified articles, 13 matched all inclusion criteria. In only four of these studies were costs reported by modified Rankin Scale categories. Most studies included direct medical costs only. Societal costs were assessed in two studies. Overall, studies had a high methodological and reporting quality. The heterogeneity in costing methods used in the identified studies prevented meaningful comparison of the reported cost data. Despite this limitation, the costs consistently increased with greater severity (increasing modified Rankin Scale score).
Conclusions: Few cost studies of stroke include information based on stroke recovery measured by individual modified Rankin Scale categories and the existing data are limited. To reliably capture this information, future studies are needed that preferably apply standardised costing methods to promote greater potential for use in cost-effectiveness analyses whereby direct collection of patient-level resource use has not been possible.

Citation

Wilson, A., Bath, P. M., Berge, E., Cadilhac, D. A., Cuche, M., Ford, G. A., …Lees, K. R. (2017). Understanding the relationship between costs and the modified Rankin Scale: a systematic review, multidisciplinary consensus and recommendations for future studies. European Stroke Journal, 2(1), https://doi.org/10.1177/2396987316684705

Journal Article Type Article
Acceptance Date Nov 23, 2016
Online Publication Date Dec 22, 2016
Publication Date Mar 1, 2017
Deposit Date Aug 16, 2017
Publicly Available Date Aug 16, 2017
Journal European Stroke Journal
Electronic ISSN 2396-9873
Publisher SAGE Publications
Peer Reviewed Peer Reviewed
Volume 2
Issue 1
DOI https://doi.org/10.1177/2396987316684705
Keywords Health economics, modified Rankin Scale, stroke, systematic review
Public URL http://eprints.nottingham.ac.uk/id/eprint/44948
Publisher URL http://journals.sagepub.com/doi/10.1177/2396987316684705
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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