Citizens from 13 countries share similar preferences for COVID-19 vaccine allocation priorities.

How does the public want a COVID-19 vaccine to be allocated? We conducted a conjoint experiment asking 15,536 adults in 13 countries to evaluate 248,576 profiles of potential vaccine recipients who varied randomly on five attributes. Our sample includes diverse countries from all continents. The results suggest that in addition to giving priority to health workers and to those at high risk, the public favors giving priority to a broad range of key workers and to those with lower income. These preferences are similar across respondents of different education levels, incomes, and political ideologies, as well as across most surveyed countries. The public favored COVID-19 vaccines being allocated solely via government programs but were highly polarized in some developed countries on whether taking a vaccine should be mandatory. There is a consensus among the public on many aspects of COVID-19 vaccination, which needs to be taken into account when developing and communicating rollout strategies.

The effect of ESG and CSR attitude on financial performance in Europe: A quantitative re-examination.

Focusing on the European context, this paper re-examines the relationship between the ESG and financial performance and whether CSR attitude moderates this relationship. A panel data set with all the listed companies in STOXX Europe 600, covering the period 2012-2022 was built, with company data being sourced from the Refinitiv Eikon platform for a total of 6600 firm-year observations. Six measures of financial performance and three regression frameworks were considered for analysis. Overall, inconsistent patterns of effect are identified across ESG predictors and financial performance measures. The presence of a CSR committee was found to negatively moderate the effect of ESG score on ROA only, whereas an external auditor to the CSR report to negatively moderate it with share price. Future research should consider replicating the proposed re-examination framework in other data settings and legislative and accounting contexts to strengthen the current evidence base and therefore deepen our understanding of the mechanisms underlying the investigated relationships.

Socio-economic accounting of inequalities in excess weight: a population-based analysis.

BACKGROUND: The prevalence of excess weight has been increasing globally in the last decades, affecting disproportionally adults from low socio-economic backgrounds and putting undue pressure on health systems and societal resources. In England, tackling unfair and unjust health inequalities is at the heart of national public health policy, and a prerequisite for enabling these decision makers to set policy priorities is an understanding of the prevalence and determinants of excess weight inequalities in their local population. METHODS: We conducted both pooled (England) and regional-level (nine regions: North-East, North-West, Yorkshire and Humber, East Midlands, West Midlands, East of England, London, South East and South West) analyses of individual level data from a nationally representative sample of adults (N = 6,387). We used the Corrected Concentration Index (CCI) to measure absolute inequalities in excess weight across three dimensions of socio-economic deprivation: neighbourhood-level deprivation, occupational status and educational qualification. We used a Shapley decomposition method to evaluate their relative contribution to inequality. RESULTS: At a national level, all three dimensions of socio-economic deprivation were found to be positively associated with excess weight across the adult population, as measured by the CCI, with educational qualification ranking first [CCI: -0.090, p < 0.01], closely followed by neighbourhood-level deprivation [CCI: -0.050, p < 0.01]. Large variation was found between regions and genders, with inequality being either considerably higher or exclusively patterned among women. The strongest independent factor contributing to excess weight inequalities was having a long-lasting limiting illness, especially among women and towards the right tail of the excess weight spectrum. Heterogeneous patterns of contribution across the excess weight spectrum were found, however age played a dominant role toward the left tail of the distribution. CONCLUSIONS: While socio-economic inequalities in excess weight exist in the English adult population, our findings underscore the importance of considering multiple dimensions of deprivation and the unique needs of different populations when developing policies to address overweight and obesity. Targeted interventions for adults with overweight and obesity with long-lasting illnesses and women can generate both short-term and long-term economic benefits, by reducing healthcare costs and increasing workforce productivity.

The independent and moderating role of choice of non-financial reporting format on forecast accuracy and ESG disclosure.

Over the last two decades, the non-financial disclosure requirement has become a major concern for companies, consumers, governments, and policymakers. While compelling evidence has accumulated over time on the positive effect that moving away from disclosing non-financial information within mandatory financial statements, conflicting findings have emerged on the relative merits that choice of non-financial reporting format, in particular between sustainability and integrated reporting, can have on analysts' forecast accuracy. In addition, recent evidence from a non-voluntary setting has suggested that such choice could influence the effect of ESG disclosure and consequently reduce information asymmetry. Aiming to shed some light on these propositions within a voluntary setting, we conducted an empirical study focusing on a representative sample of listed European companies. We retrieved and analysed the last ten years (2012-2021) of publicly available financial information about the top 600 companies listed in the Eurostoxx. Our findings indicate that both a sustainability and an integrated report are significantly associated with improved forecast accuracy, relative to an annual report. We also find that ESG disclosure is significantly moderated by such choice. The environmental pillar score was found to strongly and positively affect forecast error, independently from other controls including the social and governance pillars. For companies opting to disclose non-financial information within an annual report, alternative forms of communication will therefore become critical to ensure that financial analysts, and ultimately investors, are informed about the company's sustainability-related activities and plans. Future research should be directed at examining the magnitude and direction of these effects among small and medium-size listed companies and in other decision-making settings to test the generalisability of these findings.

Cost-Effectiveness of Mechanical Thrombectomy for Treatment of Nonminor Ischemic Stroke Across Europe.

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) has been recommended for the treatment of nonminor ischemic stroke by national and international guidelines, but cost-effectiveness evidence has been generated for only a few countries using heterogeneous evaluation methods. We estimate the cost-effectiveness of MT across 32 European countries. METHODS: A Markov model was developed to estimate the cost-effectiveness of MT compared with standard care over a 5-year time horizon. Patients with ischemic stroke eligible for MT were identified from 2017 country-specific incidence data. A societal perspective was adopted, including health, social, and informal care costs, and productivity losses. Model outcomes were expressed as quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of findings. RESULTS: We identified 267 514 ischemic stroke cases that were eligible for MT treatment across 32 European countries. MT was found to be more effective and cheaper than standard care in two-thirds of the countries (21/32) and cost-effective in all but one country (Bulgaria). Across Europe, the intervention was estimated to produce over 101 327 additional quality-adjusted life years (95% uncertainty interval, 65 180-149 085) and cost savings of $981 million (€868 million, 95% uncertainty interval, -1544 to 2564) and of $1.7 billion (€1.5 billion, 95% uncertainty interval, -1.2 to 3.6) in health and social care and societal costs, respectively. CONCLUSIONS: MT is highly likely to be cost-effective compared with standard care across Europe as a whole and in the vast majority of European countries.

Cost-effectiveness of a proportionate universal offer of free exercise: Leeds Let's Get Active.

BACKGROUND: The purpose of this paper is to assess the cost-effectiveness of a proportionate universal programme to reduce physical inactivity (Leeds Let us Get Active (LLGA)) in adults. METHODS: A continuous-time Markov chain model was developed to assess the cost implications and QALY gains associated with increases in physical activity levels across the adult population. A parametric survival analysis approach was applied to estimate the decay of intervention effect over time. Baseline model data were obtained from previous economic models, population-based surveys and other published literature. A cost-utility analysis was conducted from a health care sector perspective over the programme duration (39 months). Scenario and probabilistic sensitivity analyses were performed to test the robustness of cost-effectiveness results. RESULTS: In total, 51 874 adult residents registered to the programme and provided baseline data,19.5% of which were living in deprived areas. Under base case assumptions, LLGA was found to be likely to be cost-effective. However, variations in key structural assumptions showed sensitivity of the results. CONCLUSIONS: Results from this study suggest a non-negligible level of uncertainty regarding the effectiveness, and therefore, cost-effectiveness of a universal offer of free leisure centre-based exercise that targets hard to reach groups. Further data collection and a shift towards prospective evaluations are needed.

Lessons from the pandemic on the value of research infrastructure.

The COVID-19 pandemic has shed a spotlight on the resilience of healthcare systems, and their ability to cope efficiently and effectively with unexpected crises. If we are to learn one economic lesson from the pandemic, arguably it is the perils of an overfocus on short-term allocative efficiency at the price of lack of capacity to deal with uncertain future challenges. In normal times, building spare capacity with 'option value' into health systems may seem inefficient, the costs potentially exceeding the benefits. Yet the fatal weakness of not doing so is that this can leave health systems highly constrained when dealing with unexpected, but ultimately inevitable, shocks-such as the COVID-19 pandemic. In this article, we argue that the pandemic has highlighted the potentially enormous option value of biomedical research infrastructure. We illustrate this with reference to COVID-19 response work supported by the United Kingdom National Institute for Health Research Oxford Biomedical Research Centre. As the world deals with the fallout from the most serious economic crisis since the Great Depression, pressure will soon come to review government expenditure, including research funding. Developing a framework to fully account for option value, and understanding the public appetite to pay for it, should allow us to be better prepared for the next emerging problem.

How much behaviour change is required for the investment in cycling infrastructure to be sustainable? A break-even analysis.

BACKGROUND: Active travel has gained traction among policy makers as a promising solution to physical inactivity. Returns on active travel investments, including cycling infrastructure, crucially rely on resulting improvements in population behaviours. Estimating the expected economic value that an additional regular cyclist will generate and being able to identify the behaviour change required at the population level to offset the intervention costs is important to inform future investment decisions. METHODS: The WHO's Health Economic Assessment Tool was employed to conduct a break-even analysis. A case study methodology was used which focused on a real-world construction project of a separated cycleway in the UK. The economic assessment considered physical activity benefits, air pollution, crash risk and carbon emissions in monetary terms. An iterative computational approach was applied to identify the behaviour change (cycling) requirements, and corresponding benefits valued using international dollars, to break even on the investment costs. Sensitivity analyses were conducted to assess robustness of the base-case results. RESULTS: Over a ten-year time horizon, an additional regular cyclist (i.e., someone cycling most days of the week) was found to generate $798 (£533) per annum (international dollars). An additional 267 regular cyclists per km were required to break even on the construction of the new separated cycleway. Estimates were particularly sensitive to variations to age, cycling volume and evaluation time horizon. CONCLUSIONS: Policymakers planning to invest in cycling infrastructure should consider using these reproducible, order-of-magnitude estimates to complement the more comprehensive transport appraisal and budget allocation processes. This would ensure that, when considering its health-related economic benefits, the investment is justifiable on economic sustainability grounds.

Prevalence, predictors and reasons for COVID-19 vaccine hesitancy: Results of a global online survey.

Vaccine hesitancy has the potential to cripple efforts to end the COVID-19 pandemic. Policy makers need to be informed about the scale, nature and drivers of this problem, both domestically and globally, so that effective interventions can be designed. To this end, we conducted a statistical analysis of data from the CANDOUR survey (n = 15,536), which was carried out in 13 countries representing approximately half of the global population. Both pooled and country-level ordered regression models were estimated to identify predictors of vaccine hesitancy and reasons for not getting vaccinated. We found high levels of hesitancy, particularly in high-income countries. Factors driving moderate hesitancy differed from those driving extreme hesitancy. A lack of trust in health care providers was consistently the underlying driver of more extreme hesitancy. Predictors of moderate hesitancy varied across countries, though being younger and female was typically associated with greater hesitancy. While political ideology played a role in vaccine hesitancy in some countries, this effect was often moderated by income level, particularly in the US. Overall, the results suggest that different interventions such as mass-media campaigns and monetary incentives may be needed to target the moderately versus extremely hesitant. The lack of trust in health care professionals that drives extreme hesitancy may reflect deep societal mistrust in science and institutions and be challenging to overcome.

Cost-effectiveness of home-based stroke rehabilitation across Europe: A modelling study.

The aim of this study was to explore the cost-effectiveness of home-based versus centre-based rehabilitation in stroke patients across Europe. A state-transition cohort model was developed to simulate the impact of the intervention in 32 European countries. A cost-utility analysis was conducted from a societal perspective including healthcare, social care and informal care costs, and productivity losses. Health outcomes were expressed as QALYs. Sensitivity analyses were conducted concerning model input values and structural assumptions. Data were obtained from a population-based cohort and previously published studies. Across Europe, over 855,000 patients with stroke would be eligible for rehabilitation in 2017. Europe-wide implementation of home-based rehabilitation was estimated to produce 61,888 additional QALYs (95% CI: 3,609 to 118,679) and cost savings of €237 million (95% CI: -237 to 1,764) and of €352 million (95% CI: -340 to 2,237) in health- and social-care and societal costs, respectively. Under base case assumptions, home-based rehabilitation was found highly likely to be cost-effective (>90%), compared to centre-based rehabilitation, in most European countries (29 out of 32). Evidence from this study suggests that a shift from a centre-based to a home-based approach to stroke rehabilitation is likely to be good value for money in most European countries. Further research should be conducted to assess the generalisability of these findings to local settings.

Does providing everyone with free-of-charge organised exercise opportunities work in public health?

BACKGROUND AND PURPOSE: Population-level initiatives of free-of-charge organised exercise have been implemented to encourage residents to take up regular physical activity. However, there exists a paucity of evidence on the ability of these interventions to attract and engage residents, especially targeted subgroups. Seeking to contribute to this evidence base, we evaluated a proportionate universal programme providing free exercise sessions, Leeds Let's Get Active. METHODS: Descriptive statistics were used to summarise the programme data and participants. Time to event, count and logistic regression models examined how different population subgroups engaged with the programme in terms of number of entries, weekly participation rates and drop-off patterns. RESULTS: 51,874 adult residents registered to the programme and provided baseline data (2013-2016). A small proportion (1.6%) attended the free sessions on a weekly basis. Higher participation rates were estimated for the groups of males, retired and non-inactive participants. A neighbourhood-level deprivation status was found to have no marginal effect on the level and frequency of participation, but to be negatively associated with participation drop-off (HR 0.93, 95% CI 0.89-0.97, p = 0.001). CONCLUSIONS: Providing everyone with free-of-charge organised exercise opportunities in public leisure centres located in deprived areas can attract large volumes of residents, but may not sufficiently encourage adults, especially inactive residents and those living in disadvantaged neighbourhoods, to take up regular exercise.

Using Economics to Impact Local Obesity Policy: Introducing the UK Centre for Economics of Obesity (CEO).

Worldwide, population obesity levels are at their highest recorded levels, having nearly tripled between 1975 and 2016. This leads to substantial pressure on health systems, a negative impact on economic development, and results in adverse physical and mental health outcomes. There are many economic reasons why reducing population obesity should be a priority, and global targets have been set with many governments pledging to reduce obesity levels by 2030. To achieve these targets, a 'system-wide' approach has been widely advocated in direct recognition of the wide-ranging complex interacting determinants of the disease. This system approach requires action at all levels, including at the local government level, to use all fiscal and non-fiscal levers to bring about local system change that promotes healthier population behaviours. Like many country contexts, in England, local resources for achieving this system change have been drastically reduced in recent years. Economic evaluation offers a formal explicit framework to support local decision making but, to date, there has been a disconnect between national guidance on cost-effectiveness and how that informs local action. A new Centre for Economics of Obesity has been purposively developed to work closely with local government to adapt methods to help achieve efficiency and equity gains. By working across six workstreams to begin with, this Centre will use economics to inform policy action on different but interrelated parts of the obesity system and act as a training hub for health economists working in obesity policy.

Is There Broad-Based Support in High-Income Countries for COVID-19 Vaccine Donation? Evidence from Seven Countries.

BACKGROUND: Many high-income countries (HICs) have now vaccinated a substantial proportion of their population against COVID-19. Many low-income countries (LICs) may need to wait until at least 2022 before even the most vulnerable 20% of their populations are vaccinated. Beyond ethical considerations, some redistribution of doses would reduce the risk of the emergence and spread of new variants and benefit the economy, both globally and in donor countries. However, the willingness of HIC governments to donate vaccine doses is likely to depend on public support. While previous work has indicated strong average levels of public support in HIC for donation, little is known about how broad-based this support is. OBJECTIVE: To investigate the extent to which support for donation holds across both pre-specified and exploratory subgroups. METHODS: From 24 November-28 December 2020 we conducted an online survey of 8209 members of the general public in seven HIC (Australia, Canada, France, Italy, Spain, UK and USA). We conducted tests of proportions and used Bayesian ordinal logistic regression models to assess the extent of support for donation across population subgroups. RESULTS: We found broad-based support for donations in terms of age, gender, socio-economic status and political ideology. We found no strong evidence that support for donations was higher among those with greater income or a university education. Support for donation among those on the political right and centre was lower than on the left, but 51% (95% confidence interval 48-53%) of respondents who identified with the right supported some level of donation. Those in the more altruistic half of the sample (as captured by willingness to donate money to a good cause) were more likely to support donation than those who were not, but around half of the less altruistic group supported some level of donation. CONCLUSION: There is broad-based support for policymakers in HICs to donate some of their countries' COVID-19 vaccine doses for distribution to LICs.

Modelling decay in effectiveness for evaluation of behaviour change interventions: a tutorial for public health economists.

BACKGROUND AND PURPOSE: Recent methodological reviews of evaluations of behaviour change interventions in public health have highlighted that the decay in effectiveness over time has been mostly overlooked, potentially leading to suboptimal decision-making. While, in principle, discrete-time Markov chains-the most commonly used modelling approach-can be adapted to account for decay in effectiveness, this framework inherently lends itself to strong model simplifications. The application of formal and more appropriate modelling approaches has been supported, but limited progress has been made to date. The purpose of this paper is to encourage this shift by offering a practical guide on how to model decay in effectiveness using a continuous-time Markov chain (CTMC)-based approach. METHODS: A CTMC approach is demonstrated, with a contextualized tutorial being presented to facilitate learning and uptake. A worked example based on the stylized case study in physical activity promotion is illustrated with accompanying R code. DISCUSSION: The proposed framework presents a relatively small incremental change from the current modelling practice. CTMC represents a technical solution which, in absence of relevant data, allows for formally testing the sensitivity of results to assumptions regarding the long-term sustainability of intervention effects and improving model transparency. CONCLUSIONS: The use of CTMC should be considered in evaluations where decay in effectiveness is likely to be a key factor to consider. This would enable more robust model-based evaluations of population-level programmes to promote behaviour change and reduce the uncertainty surrounding the decision to invest in these public health interventions.

Informing radiotherapy decisions in stage I/IIa Hodgkin lymphoma: modeling life expectancy using radiation dosimetry.

In recent randomized trials, omitting consolidative radiotherapy (RT) in early-stage Hodgkin lymphoma (ESHL) increased relapses. However, decades of follow-up are required to observe whether lower initial disease control is compensated by reduced risk of late effects. Extrapolation beyond trial follow-up is therefore necessary to inform current treatment decisions. To this end, we developed a microsimulation model to estimate lifetime quality-adjusted life years (QALYs) after combined modality treatment (CMT) or chemotherapy-alone for stage I/IIa ESHL. For CMT, the model included risks of breast and lung cancer, coronary heart disease, and ischemic stroke. Comparative outcomes were assessed for a clinically relevant range of example patients differing by age, sex, smoking status, and representative organs at risk (OAR) radiation doses informed by the RAPID trial. Analysis was performed with and without a 3.5% discount rate on future health. Smoking status had a large effect on optimal treatment choice. CMT was superior for nearly all never smoker example patients regardless of age, sex, and OAR doses. At a maximum, CMT produced a 1.095 (95% CI: 1.054-1.137) gain in undiscounted QALYs for a 20-year-old male never smoker with unilateral neck disease. In contrast, current smokers could substantially gain from chemotherapy-alone treatment. Again at a maximum, a 20-year-old male current smoker with bilateral neck and whole mediastinum involvement gained 3.500 (95% CI: 3.400 to 3.600) undiscounted QALYs with chemotherapy-alone treatment. Overall, CMT was more favorable the younger the patient, when future health discounting was included, and in never smokers.

Vaccine uptake and constrained decision making: The case of Covid-19.

Policy makers require support in conceptualizing and assessing the impact that vaccination policies can have on the proportion of the population being vaccinated against COVID-19. To this purpose, we propose a behavioural economics-based framework to model vaccination choices. We calibrate our model using up-to-date surveys on people attitudes toward vaccination as well as estimates of COVID-19 infection and mortality rates and vaccine efficacy for the UK population. Our findings show that vaccine campaigns hardly reach herd immunity if the sceptics have real-time information on the proportion of the population being vaccinated and the negationists do not change their attitudes toward vaccination. Based on our results, we discuss the main implications of the model's application in the context of nudging and voluntariness versus mandatory rule-based policies.

Taking a local government perspective for economic evaluation of a population-level programme to promote exercise.

BACKGROUND: In order to tackle the issue of physical inactivity, local governments have implemented population-level programmes to promote exercise. While evidence is accumulating on the cost-effectiveness of these interventions, studies have typically adopted a health sector perspective for economic evaluation. This approach has been challenged as it does not allow for key concerns by local governments, which are primary stakeholders, to be addressed. OBJECTIVES: To show how taking a local government perspective for economic evaluation can be implemented in practice and this may affect the economic conclusions. METHODS: Based on data from a case study, the health equity impact of the intervention and its opportunity cost from a service provider viewpoint were assessed. The cost-effectiveness implications of a change in perspective were subsequently estimated by means of scenario analysis. FINDINGS: The intervention was found to provide adult residents living in the most deprived city areas with greater health benefits compared with the rest of the population. However, a negative net equity impact was found in the short-term. The opportunity cost of the intervention was estimated to be substantially lower than its financial cost (£2.77 per person/year), with significant implications for decision-making. CONCLUSIONS: Taking a local government perspective can affect the conclusions drawn from the economic evaluation of population-level programmes to promote exercise, and therefore influence decision making.

Copula Models for Addressing Sample Selection in the Evaluation of Public Health Programmes: An Application to the Leeds Let's Get Active Study.

Sample selectivity is a recurrent problem in public health programmes and poses serious challenges to their evaluation. Traditional approaches to handle sample selection tend to rely on restrictive assumptions. The aim of this paper is to illustrate a copula-based selection model to handle sample selection in the evaluation of public health programmes. Motivated by a public health programme to promote physical activity in Leeds (England), we describe the assumptions underlying the copula selection, and its relative advantages compared with commonly used approaches to handle sample selection, such as inverse probability weighting and Heckman's selection model. We illustrate the methods in the Leeds Let's Get Active programme and show the implications of method choice for estimating the effect on individual's physical activity. The programme was associated with increased physical activity overall, but the magnitude of its effect differed according to adjustment method. The copula selection model led to a similar effect to the Heckman's approach but with relatively narrower 95% confidence intervals. These results remained relatively similar when different model specifications and alternative distributional assumptions were considered. The copula selection model can address important limitations of traditional approaches to address sample selection, such as the Heckman model, and should be considered in the evaluation of public health programmes, where sample selection is likely to be present.

Modelling the impact of physical activity on public health: A review and critique.

BACKGROUND: While several reviews have assessed economic evaluations of physical activity in public health and, in most cases, found the interventions to be cost-effective, the validity of the conclusions reached depends on the appropriateness of the modelling methods used in the individual studies. OBJECTIVE: To provide an overview and critique of modelling approaches and key structural assumptions used in applied studies to estimate the impact of physical activity on population health. METHODS: Electronic databases were systematically searched for relevant model-based economic evaluations. A thematic approach was used to assess the modelling studies. The critique determined the appropriateness of the modelling frameworks and plausibility of key structural assumptions. RESULTS: Twenty-five models were identified. Cohort models were most frequently used. High variability in the modelling of downstream diseases was found across studies analysing similar populations. Structural assumptions regarding the dynamics of change of physical activity were unrealistic in most cases. Heterogeneity was addressed in only a few studies, while health equity concerns were, at best, acknowledged by authors. CONCLUSIONS: This literature is predominantly characterised by modelling approaches that may not adequately address the complexities associated with representing the physical activity behaviour- population health process. A consensus on how to model the impact of physical activity on public health and development of a reference model could help reduce these sources of uncertainty.

Economic burden of stroke across Europe: A population-based cost analysis.

INTRODUCTION: In 2017, 1.5 million people were diagnosed with stroke, 9 million were living with stroke and 0.4 million died because of stroke in 32 European countries. We estimate the economic burden of stroke across these countries in 2017. PATIENTS AND METHODS: In a population-based cost analysis, we evaluated the cost of stroke. We estimated overall health and social care costs from expenditure on care in the primary, outpatient, emergency, inpatient and nursing/residential care settings, and pharmaceuticals. Additionally, we estimated the costs of unpaid care provided by relatives or friends of patients, lost earnings due to premature death and costs associated with individuals who temporarily or permanently left employment because of illness. RESULTS: In 2017 stroke cost the 32 European countries under analysis €60 billion, with health care accounting for €27 billion (45%), representing 1.7% of health expenditure. Adding the costs of social care (€5 billion), annual stroke-related care costs were equivalent to €59 per citizen, varying from €11 in Bulgaria to €140 in Finland. Productivity losses cost €12 billion, equally split between early death and lost working days. A total of €1.3 billion hours of informal care were provided to stroke survivors, costing Europe €16 billion. CONCLUSION: Our study provides a snapshot of the economic consequences posed by stroke to 32 European countries in 2017. It also strengthens and updates the evidence we have gathered over the last 15 years, indicating that the costs of stroke are rising, partly due to an ageing population.