$2.2 trillion stroke cost projected
Wednesday, November 1, 2006
PTINR.com Staff
Increases in select ethnic group, high-risk populations are the primary reason for the a dramatic, projected increase in ischemic stroke.
Ischemic stroke cost projections predicted to hit 2.2 trillion by 2050. Ironically, drug cost barely enters into the overall costs. A MedPage Today article published these sobering figures in their August 16, 2006 online service. Experts described 2.2 trillion cost figure as “conservative”.
An aging population combined with increasing populations of ethnic groups have been “the perfect demographic storm”. Stroke focus remains on acute treatment rather than longer term prevention.
CDC data has demonstrated certain ethnic groups are at increased risk for ischemic stroke. The increased population of African American and Hispanic populations accelerate the rates of stroke as these two groups have, historically, demonstrated higher rates of stroke over other ethnic groups.
MedPage, 2006
“That shift is important because the weighted average annual incidence of stroke is 11 per 10,000 for whites younger than 64 and 60 per 10,000 for those 65 to 84, versus 23 per 10,000 for Hispanics ages 45 to 64, and 87 per 10,000 for Hispanics ages 65 to 84. Among those 85 or older the rate was 180 per 10,000 for both whites and Hispanics.
African-Americans have the highest ischemic stroke risk for those younger than 65, 33 per 10,000, but the risk for African Americans 65 to 84 is the same as Hispanics. African Americans who reach age 85 have a slightly lower stroke incidence than either whites or Hispanics, 170 per 10,000 population.”
MedPage, 2006
Experts agree now is the time to avoid the 2.2 trillion dollar price tag for ischemic stroke forty-five years from now.
"Doing the right thing now ultimately could be cost-saving in the future, but we have a long way to go before all Americans receive adequate stroke prevention and emergency stroke care," cite authors of Neurology.
The combination of a increasing aging population, accelerated ethnic population growth combined with the disproportionate cost of stroke seem to validate the $2.2 trillion dollar price tag projection.
MedPage, 2006
University of Pennsylvania researchers recommend more widespread use of current treatments combined with improved control of hypertension and smoke cessation.
“There is an urgent need for cost-saving treatments such as Coumadin® (warfarin) treatment for primary prophylaxis of atrial fibrillation and use of thrombolytic drugs such as Alteplase (recombinant tissue plasminogen activator) for ischemic stroke, as well as cost-effective treatments such as carotid endarterectomy.
Numerous studies have demonstrated the underutilization of warfarin, particularly in sub-sets of various cultures. To come under the $2.2 trillion cost figure – increase use of warfarin remains a first-line strategy. Improving control of warfarin seems like a parallel step to increasing utilization. More frequent testing and improving INR control seems prudent. Increased utilization of warfarin (Coumadin ®) without investing in improving control may result in increased hemorrhagic stroke and even more cost.
Medicare will need to allocate budgets to accommodate all indications of warfarin to reflect the new standard of care of weekly testing for patients on warfarin.
Human nature and medical practice has shown we remain a reactive society. A shift to preventative care has been proposed prescription for coming in under the forecasted ischemic stroke budget.