Priority Medicines for Europe and the World 2013 Update. Background Paper 6 - Priority Diseases and Reasons for Inclusion. BP 6.06 - Cancer and Cancer Therapeutics
(2012; 46 pages)


Stroke is the second leading cause of death worldwide and in the European region. Ten per cent of the 55 million deaths that occur every year worldwide are due to stroke. The overall mortality from stroke has been declining both worldwide and in Europe. This is mainly due to improved access to appropriate health care, with the consequent rise in health care costs. In Europe, discharges following hospitalization for stroke doubled during the last 15 years of the twentieth century. The United Kingdom spends 6% of its national health budget on stroke care, twice as much spent on ischaemic heart disease (IHD).

The successful management of acute stroke is based on imaging followed by two main strategies: vascular recanalization and supportive care...

Despite improvements in care, sequelae of stroke remain a major problem. Fifty to seventy per cent of those who survive an ischaemic stroke will recover functional independence three months after onset, but 20% will require institutional care. Stroke is the second leading cause of disability in Europe after ischaemic heart disease (IHD). Worldwide, stroke is the sixth leading cause of disability. It is also the second leading cause of mortality in Europe and worldwide.

The economic impact of stroke care goes beyond the costs of sophisticated acute care, costly secondary prevention (carotid endarterectomy) and its prolonged high dependent institutional chronic care as well as costs of rehabilitation. Neither mortality rate nor hospital discharges accurately reflect the level of disability, which is mainly borne by patients and their families.

There is little progress being made in research and development of drugs for treating acute stroke, particularly in the field of neuroprotection. Surprisingly low levels of resources have been devoted to research and development of drugs for treating stroke during the last 30 years (no more than 10% of those invested in IHD or cancer).
Major improvements are needed in the chain of care for identification of stroke by relatives (education); early treatment (possibly with aspirin); the prompt referral to an accident and emergency facility (mobile units); accurate diagnosis and fast appropriate treatment (protocols and specialized units); improving access to expanded and more efficacious therapeutic options; and prompt referral to rehabilitation services.

As "time is brain", more efficacious treatments provided early in the chain of care are needed to minimise disability and avoid future suffering as well as reducing the economic costs in societies with higher ageing populations.

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