Economic burden of stroke and the evaluation of new therapies.

Stroke is a major health problem in all industrialised countries and evidence is mounting that this problem also affects the developing countries. In the industrialised countries, it is the third largest killer and, of the survivors, about one-half are left with a permanent handicap. Despite the huge burden of stroke on healthcare and social services (several USA studies estimate the annual cost of stroke to be between US $6.5 and 11.2 billion) the cost of strokes has aroused little attention. An absence of effective therapies may be one of the reasons for 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 clinical and economic) of new stroke therapies is the choice of evaluation scales/instruments. Increasingly, stroke investigators are using measures of functional outcome (for example the Barthel index) as a primary endpoint in stroke trials. This is pertinent, as functional outcome has been found to reflect reasonably well the degree to which a patient needs support after stroke, irrespective of whether this is provided by the family or society.