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

Wilson, A. et al. (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), pp. 3-12. (doi: 10.1177/2396987316684705)

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.

• Item Type: Articles
• Additional Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the European Stroke Organisation (ESO) and Virtual International Stroke Trials Archive (VISTA). VISTA is a not-for-profit collaboration of researchers from academia and commercial organisations. PMB is Stroke Association Professor of Stroke Medicine. TQ is funded by a joint Stroke Association / Chief Scientist Office Senior Clinical Lecturer Fellowship.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Macisaac, Dr Rachael and Lees, Professor Kennedy and Quinn, Professor Terry and Wilson, Dr Alastair and Walters, Professor Matthew
• Authors: Wilson, A., Bath, P. M.W., Berge, E., Cadilhac, D. A., Cuche, M., Ford, G. A., Macisaac, R., Quinn, T. J., Taylor, M., Walters, M., Wolff, C., and Lees, K. R.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: European Stroke Journal
• Publisher: SAGE Publications
• ISSN: 2396-9873
• ISSN (Online): 2396-9881
• Published Online: 22 December 2016
• Copyright Holders: Copyright © 2016 SAGE Publications
• First Published: First published in European Stroke Journal 2(1):3-12
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher