Estimating the cost-effectiveness of stroke units in France compared with conventional care.

BACKGROUND AND PURPOSE: The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year. This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. METHODS: Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. RESULTS: Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 for conventional care and 34 638 in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 per year of life gained without disability was estimated. CONCLUSIONS: The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 ) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

[Knowledge of an urban population about arterial hypertension: prospective study carried out in Ouagadougou, Burkina Faso]. / Connaissances d'une population urbaine sur l'hypertension artérielle: enquête prospective menée à Ouagadougou, Burkina Faso.

The objective of this prospective survey was to estimate the prevalence of hypertension in the city of Ouagadougou and to evaluate the information level as well as the knowledge of the population regarding hypertension. We carried out a urban community based cross sectional study. Subjects were black African, and aged of 18 years at least. They were considered hypertensive when they were under a treatment for hypertension, or when they had high blood pressure (> or = 140/90 mm Hg) according to the WHO classification in 1999. The study selected 3441 subjects, among them 60.4% of women and 39.6% of men. The average age in the sample was 33.1 +/- 13.3 years; 64.4% of the subjects were 20 to 40 years old. The average systolic blood pressure in the population was of 124 +/- 21 mm Hg, and of 78 +/- 12 mm Hg for the diastolic one. The prevalence of hypertension in our sample was 23%, with 20.4% of unknown hypertensive subjects. Hypertension is highly frequent in urban area in Burkina Faso. As it could be expected, the knowledge of the population regarding hypertension proved inversely proportional to the educational level. Information programs and consciousness-raising campaign as well as detection program should be implemented urgently.