Cámara termográfica

Stroke is one of the leading causes of mortality and morbidity in the UK. The financial burden of stroke can impact on the economy, the healthcare service and an individual who has had a stroke and their family members and carers. It is useful to consider different perspectives when describing the economic impact of stroke. The societal viewpoint considers the effect on the entire economy. In 2008, the National Audit Office estimated that stroke cost the British Economy to be £7bn. This figure includes direct costs of informal care and the indirect costs as a result of lost productivity resulting from potentially economically active members of society being unable to work. A major impact of stroke is the hidden cost of providing informal care for people suffering from the sequelae of a previous stroke. There are around 900,000 people living in England who

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have had a stroke and approximately half of these will be dependent on others for performing their daily activities, which results in estimates of informal care costs of around £2.4 billion (National Audit Office, 2005). Stroke is not only experienced by older people. Around one quarter of all strokes occur in people of working age, with productivity losses resulting in annual indirect costs of £1.8 billion (National Audit Office, 2005).

It is estimated that major stroke costs in the region of £2.8bn in direct hospital care and accounts for almost 5% of all health service costs in the UK (Hankey, 2008, National Audit Office, 2005). The societal burden of stroke is higher, with one source estimating this at £8.9bn (Saka et al., 2009). Stroke has a larger financial burden on the NHS than heart disease (Rothwell, 2001).

It is also important to consider the economic burden on the individual whom has experienced a stroke. There are a number of potential costs to the individual. First of all, there is the direct cost for care and support if the stroke results in a disability that means they can not look after themselves or perform day-to-day tasks. Secondly, there may also be loss of earnings coupled with a rise in medical care costs resulting from prescription charges for medicines and travel costs to attend hospital and GP appointments. Stroke also has an impact on the family and friends of the person who has had a stroke. The family and friends are often the ones who provide informal care. Luengo-Fernandez et al. (2009a) estimated an average cost of stroke/TIA per patient of $22,377 US, approximately £15,700 (using the purchasing power parity exchange rate of £0.70 to 1 US$ (OECD, 2013)).

43 3.3. The budget for health care

The UK has a publicly funded healthcare system, funded in the most by centralised (UK) taxation, which is characterised by a system that is ‘free at the point of use’. The total level of funding is therefore determined every year and set by government and civil servants. In 2012 the budget was £108.8bn (Department of Health, 2012).

Up to April 2013,the annual healthcare budget for England was distributed between 152 primary care trusts (PCTs) according to population and needs, (Department of Health, 2012). PCTs had authority for purchasing healthcare from independent providers to meet local need. Since April 2013, the PCTs have been replaced by the introduction of clinical commissioning groups (CCG) which has granted more powers to GP partners to commission the goods and services they want. Healthcare decisions in the rest of the UK (Scotland, N. Ireland and Wales) remain devolved and made at country level. Across the UK. while funding is not ring-fenced, there are requirements to provide certain treatments and services, as well as quality standards (including those relating to the management of stroke patients) to try and ensure equality of access. Notwithstanding these attempts, there is still regional variation in the patient experiences regionally and nationally.

The potential management options for stroke were previously described in Chapter 2.

These interventions for the treatment and management of stroke, particularly the use of antiplatelet medicines and antihypertensive medicines to control blood pressure, have resulted in a steady decline in mortality rates. However, such interventions and management options must be funded from a finite healthcare budget. This means that the allocation of NHS resources to treat and manage stroke diverts resources from other

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healthcare treatments (for instance in heart disease, diabetes and cancer as well as less prevalent but expensive to treat diseases). Decision makers allocating healthcare resources have to make decisions about which interventions represent the most effective use of scarce resources.

In the context of stroke these decisions are whether to increase expenditures on (primary and secondary prevention) or on acute stroke unit care and rehabilitation.

Treatment versus prevention

It is estimated that one third of non-fatal strokes result in lasting disability, which imposes a significant burden to the NHS and broader economy. However, as Chapter 2 has evidenced, the sequelae of stroke could be prevented if patients with TIA were placed on appropriate secondary medications or if primary prevention measures were developed to detect and treat people with atherosclerosis or if public health measures improved healthy lifestyles in cohorts at risk of future stroke. With appropriate planning services could be set up to prevent stroke reducing the treatment burden.