ECONOMIC BURDEN OF STROKE AND THE EVALUATION OF NEW THERAPIES

Stroke is a major health problem in all industrialised countries and e vidence is mounting that this problem also affects the developing coun tries. In the industrialised countries, it is the third largest killer and, of the survivors, about one-half an left with a permanent handic ap. Despite the huge burden of stroke on healthcare and social service s (several USA studies estimate the annual cost of stroke to be betwee n US $6.5 and 11.2 billion) the cost of strokes has aroused little att ention. An absence of effective therapies may be one of the reasons fo r this lack of interest; the costs have been taken as inevitable. With the advent of new therapies for acute ischaemic stroke (thrombolytics and neuroprotectants) there is renewed interest in improving both the management and outcome for patients. Key to the evaluation (both clin ical and economic) of new stroke therapies is the choice of evaluation scales/instruments. Increasingly, stroke investigators are using meas ures of functional outcome (for example the Barthel index) as a primar y endpoint in stroke trials. This is pertinent, as functional outcome has been found to reflect reasonably well the degree to which a patien t needs support after stroke, irrespective of whether this is provided by the family or society.