Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura

OBJECTIVE: To review the bibliography on stroke costs (ICD-10 code I63) in the field of primary care. DESIGN: Systematic review. DATA SOURCES: PubMed/Medline, ClinicalTrials.gov, Cochrane Reviews, EconLit, and Ovid/Embase between 01/01/2012–12/31/2021 with descriptors included in Medical Subject Heading (MeSH). SELECTION OF STUDIES: Those with a description of the costs of activities carried out in the out-of-hospital setting. Systematic reviews were included; prospective and retrospective observational studies; analysis of databases and total or partial costs of stroke as a disease (COI). Articles were added using the snowball method. The studies were excluded because: a) not specifically related to stroke; b) in editorial or commentary format; c) irrelevant after review of the title and abstract; and d) gray literature and non-academic studies were excluded. DATA EXTRACTION: They were assigned a level of evidence according to the GRADE levels. Direct and indirect cost data were collected. RESULTS AND CONCLUSIONS: Thirty studies, of which 14 (46.6%) were related to post-stroke costs and 12 (40%) to cardiovascular prevention costs. The results show that most of them are retrospective analyzes of different databases of short-term hospital care, and do not allow a detailed analysis of the costs by different segments of services. The possibilities for improvement are centered on primary and secondary prevention, selection and pre-hospital transfer, early discharge with support, and social and health care.