Patients' productivity losses and informal care costs related to ischemic stroke: a French population-based study.

BACKGROUND AND PURPOSE: Large societal costs of stroke should not be ignored. We aimed to estimate patients' productivity losses and informal care costs during the first year after ischemic stroke. METHODS: A cross-sectional survey was performed within the STROKE69 regional population-based cohort study. At 1 year post-stroke, each patient and the corresponding main informal caregiver received questionnaires followed by a telephone interview if necessary. Time losses were valued using the human capital approach and proxy good method for patients with and without a professional activity, respectively. RESULTS: Among the 222 patients with ischemic stroke (58% men; mean age 68 years; and 86% with a modified Rankin Scale (mRS) score of <3 at 3 months), 54%, 32%, and 25% received informal, formal, and both cares, respectively. Among the 108 main informal caregivers, 63% were women, 74% lived with the patient, and 57% were retired or unemployed. The mean cost of productivity losses was estimated at €7589 ± €12 305 per patient in the first post-stroke year with 5.4%, 71.2%, and 23.4% of these being attributed to presenteeism, absenteeism, and leisure time, respectively. Informal care was given at an average of 25 h/week. The annual mean estimated total cost of informal care was €10 635 per caregiver. CONCLUSIONS: Informal care and productivity losses of patients with ischemic stroke during the first post-stroke year represent a significant economic burden for society comparable to direct costs. These costs should be included in economic evaluations with the adoption of a societal perspective to avoid underestimating the societal stroke economic burden.

Cost-effectiveness of stent-retriever thrombectomy in large vessel occlusion strokes of the anterior circulation: Analysis from the French societal perspective.

OBJECTIVES: To determine the cost-effectiveness of stent retriever thrombectomy (SRT) added to standard of care (SOC) in large vessel occlusion (LVO) strokes, adopting the French societal perspective given the lack of published studies with such perspective. METHODS: We developed an hybrid model (decision tree until one year post-stroke followed by a Markov model from one year onward). The time horizon was 20 years. We calculated transition probabilities across the modified Rankin Scale (mRS) based on a published meta-analysis. The main outcome measure was quality adjusted life-years (QALYs) gained. Resources and input costs were derived from a literature search. We calculated the incremental cost-effectiveness ratio (ICER) expressed as cost/QALY. We used 1-way deterministic and probabilistic sensitivity analysis (PSA) to evaluate the model uncertainty. RESULTS: In the base-case, adding SRT to SOC resulted in increased effectiveness of 0.73 QALY while total costs were reduced by 3,874€ (ICER of -5,400€/QALY). In the scenario analysis adopting the French healthcare system perspective, the ICER was 4,901€/QALY. Parameters the most influential were the relative risks of SRT over SOC for 90-days mortality and for 90-days mRS 0-2, and the time horizon. PSA showed the 95% confidence interval of the ICER was -21,324 to 4,591€/QALY, with SRT having 85.5% chance to be dominant and 100% to be cost-effective at a threshold of 50,000€/QALY. CONCLUSION: SRT was dominant from a French societal perspective, from 9 years post-stroke onwards. Cost-effectiveness of SRT added to SOC becomes undisputable with evidences from payer and societal viewpoints.

Valorization of winery waste vs. the costs of not recycling.

Wine production generates huge amounts of waste. Before the 1990s, the most economical option for waste removal was the payment of a disposal fee usually being of around 3000 Euros. However, in recent years the disposal fee and fines for unauthorized discharges have increased considerably, often reaching 30,000-40,000 Euros, and a prison sentence is sometimes also imposed. Some environmental friendly technologies have been proposed for the valorization of winery waste products. Fermentation of grape marc, trimming vine shoot or vinification lees has been reported to produce lactic acid, biosurfactants, xylitol, ethanol and other compounds. Furthermore, grape marc and seeds are rich in phenolic compounds, which have antioxidants properties, and vinasse contains tartaric acid that can be extracted and commercialized. Companies must therefore invest in new technologies to decrease the impact of agro-industrial residues on the environment and to establish new processes that will provide additional sources of income.

Trace metals in river bed sediments: an assessment of their partitioning and bioavailability by using multivariate exploratory analysis.

In this study, river bed sediments were submitted to a BCR sequential extraction, together with three bioavailability tests: a weak acid elutriate (HCl), a physiologically based extraction test (PBET) and a toxicity characteristic leaching procedure (TCLP). The most remarkable features of the BCR procedure were: i) Mn and Zn showed the highest proportion of the F1 exchangeable fraction; ii) in addition to Fe, Pb and Zn were the metals with the higher percentages in the F2 reducible fraction; iii) Fe and Cu were the elements with the highest proportion of the F3 oxidizable fraction; iv) the application of Principal Component Analysis to the metals in each of the three fractions did not show clear associations between metals and sediment components considered as metal scavengers, v) considering the sum of the three BCR fractions, the elements showed a decreasing availability of: Fe > Pb > Zn > Cu > Mn > Ni > Cr. The single extractions followed a decreasing extractability order of: HCl > PBET > TCLP and they were far from the extractability deduced from the sum of fractions in the BCR extraction.