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Original article
Trends in healthcare resource use and expenditure before and after ischaemic stroke. A population-based study
Evolución del gasto en servicios sanitarios antes y después del ictus isquémico: análisis de base poblacional
A. Riberaa,b,c,
Corresponding author
aidaribera@gmail.com

Corresponding author.
, E. Velad, A. García-Altésb,e,f, M. Clèriesd, S. Abilleirab,c,e
a Unidad de Epidemiología Cardiovascular, Hospital Universitario Vall d’Hebron, Barcelona, Spain
b CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
c Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Generalitat de Catalunya, Spain
d Unitat d’Informació i Coneixement, Servei Català de la Salut, Barcelona, Spain
e Agència per la Qualitat i l’Avaluació Sanitària de Catalunya, Departament de Salut, Barcelona, Spain
f Institut d’Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The growing burden of stroke has led to an increase in healthcare expenditure&#46; In addition to the high hospitalisation rates&#44; long hospital stays&#44; and need for rehabilitation associated with stroke&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the disease continues to be the leading cause of long-term disability&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Advances in acute ischaemic stroke care have increased survival rates&#44; but this has also resulted in greater numbers of survivors presenting sequelae and dependence&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Several studies have evaluated the cost of stroke&#44; with results varying greatly according to context&#44; perspectives&#44; study design&#44; and data sources&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> However&#44; no study has quantified the cost of stroke using patient data in our setting&#44; a public&#44; free-to-use healthcare system with universal coverage&#46; Furthermore&#44; few studies have compared the costs associated with stroke management against healthcare costs before stroke to calculate the incremental costs potentially attributable to stroke&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The information technology systems of the Catalan Health Service gather data on healthcare resource use from different sources&#44; providing population-based data from all healthcare system users&#46; With the system&#44; healthcare resource use can be quantified and the direct costs to the healthcare system can be calculated&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The purpose of this study is to quantify and describe healthcare expenditure &#40;excluding costs associated with emergency medical transport and orthotic&#47;prosthetic material&#41; associated with ischaemic stroke among users of the Catalan Health Service&#46; We quantified expenditure using a bottom-up approach based on resource use by all individuals presenting stroke between 2012 and 2016&#44; conducting retrospective&#44; longitudinal follow-up from one year before stroke to 3 years after the episode&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Data sources</span><p id="par0025" class="elsevierStylePara elsevierViewall">The Registry of Morbidity and Resource Utilisation of Catalonia &#40;MUSSCAT&#44; for its Spanish initials&#41; includes detailed information on the healthcare services used by the population covered&#46; It includes data from the minimum basic dataset on hospital discharges&#44; primary care consultations&#44; community healthcare&#44; emergency department visits&#44; and mental health care &#40;provided both on an inpatient and on an outpatient basis&#41;&#44; in addition to drug dispensing data and medical billing data for specialist consultations&#44; non-emergency medical transport&#44; outpatient rehabilitation&#44; home oxygen therapy&#44; and dialysis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Minimum basic datasets include automated cross-validation systems that ensure data consistency and identify any potential errors&#46; Furthermore&#44; as the data included are used for payment for medical services&#44; the database is subject to external audits every 3-5 years to ensure data quality and reliability&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The analysis of anonymised administrative data does not require patient informed consent&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study population and follow-up</span><p id="par0040" class="elsevierStylePara elsevierViewall">We included all patients admitted to hospital due to ischaemic stroke &#40;ICD-9-CM codes 433&#46;XX &#91;occlusion and stenosis of precerebral arteries&#93; and 434&#46;XX &#91;occlusion of cerebral arteries&#93;&#41; between January 2012 and December 2016&#46; We excluded patients with history of stroke in the 7 years prior to the event&#46; The time period before stroke was defined as the 12 months before the date of hospitalisation due to stroke&#44; and the follow-up period was defined either as the 3 years following the episode&#44; or as the time between the date of hospitalisation due to stroke and either the date of death or 31 December 2016&#44; whichever occurred first&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Comorbidities and&#47;or medical history were coded using the International Classification of Diseases&#44; 9th Revision&#44; Clinical Modification &#40;ICD-9-CM&#41; &#40;online Supplementary material&#44; Table I&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">We identified all drugs prescribed &#40;number of packages of any drug&#41;&#44; particularly drugs for secondary cardiovascular prevention&#44; non-steroidal anti-inflammatory drugs&#44; analgesics&#44; and antidepressants using the Anatomical Therapeutic Chemical classification codes &#40;online Supplementary material&#44; Table II&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0055" class="elsevierStylePara elsevierViewall">Data are expressed as percentages or means &#40;standard deviation &#91;SD&#93;&#41;&#46; We compared baseline patient data between men and women&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Rates of resource use and average healthcare expenditure per patient were calculated for 30-day or 365-day periods from the date of admission&#46; For each 30-day period&#44; we calculated the quotient between the sum of activity &#40;or healthcare expenditure&#41; performed over a given period and the mean number of patients at risk during said period &#40;&#91;number of patients at the beginning of the period&#160;&#43;&#160;number of patients at the end of the period&#93;&#47;2&#41;&#44; similarly to the method used in actuarial survival analysis&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">To calculate the rate of healthcare resource use per person-year and the mean healthcare expenditure per person-year&#44; we calculated the time at risk for each patient in each period&#59; time at risk ended with death or end of follow-up on 31 December 2016&#46; The numerator is the sum of activity &#40;or expenditure&#41; during that period&#44; and the denominator is the number of person-years &#40;summation of number of days at risk&#44; divided by 365&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">We established a standard cost or fee to estimate expenditure for each contact &#40;each instance healthcare service use&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> This method accounts for 97&#46;1&#37; of the Catalan Health Service&#8217;s budget&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">To calculate and graphically represent progression after stroke&#44; we defined 7-day periods from the date of admission due to stroke and gathered data on patient outcomes &#40;death&#44; at an assisted-living residence&#44; at a long-stay hospital&#44; in hospital&#41; at the end of each period&#46; Survivors not institutionalised at an assisted-living residence or in a healthcare centre were considered to be living at home&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> At baseline &#40;before hospital admission&#41;&#44; only 2 options were considered&#58; home or assisted-living residence&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">To estimate resource use and healthcare expenditure attributable to stroke&#44; we calculated the ratio between the rate of use for each resource and the difference in costs between the year before stroke and each year after stroke&#46; We calculated incremental expenditure &#40;after stroke vs before stroke&#41; for each type of resource &#40;hospital care&#44; primary care&#44; community healthcare and rehabilitation&#44; drug dispensing&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the R statistical software&#44; version 3&#46;4&#46;3&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">We identified a total of 36 044 patients older than 18 years who were admitted due to ischaemic stroke and had no history of stroke in the previous 7 years &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the baseline characteristics of the study population&#46; Women accounted for 47&#46;4&#37; of the sample&#59; mean age was 71&#46;4 years &#40;SD&#58; 13&#41; in men and 78&#46;4 &#40;12&#46;6&#41; years in women&#46; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a> shows the age and sex distribution of the sample&#46; The in-hospital mortality rate was 9&#37;&#59; 32 850 patients were discharged&#59; and 74&#37; of patients survived the first year&#44; 68&#37; survived the second year&#44; and 63&#37; survived the third year &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the utilisation rates for different healthcare resources&#44; by patient-year&#46; Mean hospitalisation time was 2&#46;3 days per patient in the year before stroke&#44; 17&#46;1 days in the first year after stroke&#44; and 3&#46;1 and 2&#46;8 days in the second and third years after stroke&#44; respectively&#46; Mean time spent at a long-stay hospital was 2&#46;2 days per patient in the year before stroke&#44; 35&#46;5 days in the first year after stroke&#44; and 4&#46;6 and 3&#46;9 days in the second and third years after stroke&#44; respectively&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">Online Supplementary material Figs&#46; I-VII show the progression of the monthly use rates of the most relevant resources&#59; a change in resource use can be observed in the months following stroke&#46; The use of some resources increases in the months before stroke&#46; For example&#44; primary care consultations &#40;Fig&#46; I&#41; increased from 120 to 150 per 100 patients&#47;month before admission due to stroke&#44; hospital admissions &#40;Fig&#46; II&#41; increased from 2&#46;5 to 5 per 100 patients&#47;month&#44; and emergency department visits &#40;Fig&#46; IV&#41; increased from 7&#46;5 to 12 per 100 patients&#47;month&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Taking the year before stroke as a reference&#44; significant increases &#40;rate ratios &#62; 1&#41; can be observed in the utilisation rate of nearly all healthcare resources &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#44; with the exception of use of non-steroidal anti-inflammatory drugs&#44; for which utilisation rates decreased&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the expenditure associated with the healthcare resources used&#46; Resource use in the year before stroke was associated with a cost of &#8364;3230 per patient&#46; In the first year after stroke&#44; healthcare expenditure amounted to &#8364;11 060 per patient-year&#58; &#8364;4434 corresponded to the costs associated with hospitalisation due to acute stroke plus any subsequent hospitalisations during the first year&#44; and &#8364;2289 corresponded to the costs associated with institutionalisation in long-stay hospitals&#46; During the second and third years&#44; total expenses amounted to &#8364;4104 and &#8364;3878&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a> shows monthly healthcare expenditure per patient on different healthcare resources during the study period&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">Taking the year prior to stroke as a reference&#44; healthcare expenditure was 3&#46;5 times greater the first year after stroke&#44; and 28&#37; and 20&#37; higher in the second and third years&#44; respectively&#46; <a class="elsevierStyleCrossRef" href="#fig0025">Fig&#46; 5</a> shows the distribution of incremental costs by resource category &#40;hospital care&#44; primary care&#44; long-stay hospital care or rehabilitation&#44; and pharmacological treatment&#41;&#46;</p><elsevierMultimedia ident="fig0025"></elsevierMultimedia></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">This study estimated the healthcare expenditure associated with management of patients with ischaemic stroke and attended under the Catalan Health Service&#44; and quantified the proportion of the cost that is attributable to stroke&#46; Average expenditure per patient was &#8364;11 060 the first year &#40;&#8364;7829 more than in the year before stroke&#41;&#46; Healthcare expenditure decreased in the second and third years&#44; stabilising at approximately &#8364;340 per month after 18 months &#40;&#8364;100 more than before stroke&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Increases in expenditure mainly result from the initial hospitalisation &#40;during the first year&#41; and additional hospital admissions &#40;in subsequent years&#41;&#46; During the second and third years after stroke&#44; expenditure associated with hospitalisation decreases considerably&#59; the costs of consultations &#40;outpatient and primary care consultations&#41; and pharmacological treatment do not decrease during this period&#44; however&#46; The percentage of total expenditure attributed to long-stay hospital care and rehabilitation is greater in the first year after stroke&#44; but continues to be a significant component of healthcare expenditure in subsequent years&#46; In the second and third years&#44; a considerable percentage of the incremental costs is attributable to pharmacological treatment&#58; in the third year after stroke&#44; annual drug expenditure per patient is &#8364;257 higher than before stroke&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">In general terms&#44; 40&#37; of the incremental expenditure potentially attributable to stroke corresponds to drug dispensing&#44; 26&#37; to hospitalisation&#44; and 24&#37; to long-stay hospital care and rehabilitation&#46; The increased use of hospital resources after stroke has already been studied in other settings&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> Although an analysis of the causes of readmission is beyond the scope of this study&#44; stroke recurrence and other cardiovascular events are known to account for a considerable proportion of readmissions&#46;<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10&#44;11</span></a> The cost associated with stroke the first year after the event is addressed in great detail in the CONOCES study&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> a prospective study collecting data from 16 Spanish hospitals for the year 2012&#46; Several other studies have analysed the costs of stroke&#44; with estimates varying greatly &#40;&#8364;5337-&#8364;27 711&#41; depending on the context&#44; perspective&#44; study design&#44; and data sources&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> The CONOCES study<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> estimated the average direct healthcare cost at &#8364;8491 for the first year after stroke&#46; This figure is similar to our estimate&#44; demonstrating that administrative databases constitute a reliable source of information for estimating resource use and healthcare expenditure&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">In addition to the well-known age-related increase in healthcare resource use&#44; expenditure on these patients increases substantially after stroke&#46; Furthermore&#44; although resource use decreases after the acute and subacute phases&#44; expenditure on some resources is far from reaching baseline &#40;pre-stroke&#41; levels&#46; These include the costs associated with hospital care&#44; specialised care &#40;outpatient consultations&#41;&#44; pharmacological treatment &#40;particularly antithrombotics and other drugs for secondary prevention of cardiovascular disease&#44; and&#44; interestingly&#44; use of analgesics and antidepressants&#44; probably as a result of disability&#41;&#44; and resources for patients with disability &#40;long-stay hospitals&#44; rehabilitation&#44; non-emergency medical transport&#41;&#46; Therefore&#44; while average expenditure stabilises within 2 years of stroke&#44; annual expenditure in the third year continues to be substantially greater than before stroke&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Patients with stroke are usually individuals of advanced age with multiple comorbidities&#44; which means that many will already be using a considerable amount of healthcare resources prior to stroke&#46; In fact&#44; healthcare expenditure before stroke in our sample amounted to &#8364;3130 per patient&#59; this is 3 times greater than the average expenditure per patient in 2014 &#40;&#8364;990&#41; and comparable to the average expenditure for patients older than 80 years&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> The value of comparing healthcare expenditure before and after stroke lies in the ability to estimate the costs attributable to stroke&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Although it is beyond the scope of the present study&#44; a detailed analysis of the reasons for hospitalisation before stroke &#40;which may include other manifestations of cardiovascular disease and episodes of atrial fibrillation&#41; may enable the identification of patients at greater risk of stroke&#44; which would in turn help in developing follow-up protocols for certain patient profiles to prevent or delay ischaemic stroke&#46; This approach may be adopted by future studies using clinical and administrative databases&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Unlike similar studies analysing healthcare costs before and after stroke&#44;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11&#44;12</span></a> our study also analysed non-hospital healthcare costs&#44; which represent a considerable percentage of overall healthcare expenditure&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In any case&#44; our study did not analyse the social costs of disability&#44; assumed by the healthcare system&#44; and the costs assumed by patients and their families &#40;informal care costs&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> direct costs associated with home adaptations&#44; and indirect costs associated with patients&#8217; or caregivers&#8217; loss of productivity at work&#41;&#44; which are believed to be even greater than healthcare costs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Population databases provide a large quantity of information relevant to the healthcare system &#40;quality indicators&#41;&#44; enabling the generation of new hypotheses for more detailed studies of clinical interest&#46; For example&#44; we were surprised to observe an increase in the use of certain resources in the months prior to stroke &#40;hospitalisation&#44; emergency department visits&#44; and primary care consultations&#41;&#44; which may have been associated with minor strokes or transient ischaemic attacks before the stroke that motivated the initial hospitalisation&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Population databases also enable the analysis of a complete patient cohort&#59; the MUSSCAT registry provides exhaustive data on healthcare contacts and resource use&#44; with the exception of emergency medical transport and orthotic&#47;prosthetic material&#59; these resources are relevant for patients with stroke&#44; and exclusion of these data may have led to an underestimation of healthcare expenditure&#46; Our cost estimates may be comparable to the actual healthcare system expenditure&#44; since most resources are linked to a billing record&#44; with the exception of hospitalisation and primary care consultations&#59; the costs associated with these resources are estimated based on diagnosis-related groups<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> and type of consultation &#40;type of healthcare professional&#44; home&#47;outpatient consultation&#41;&#44; respectively&#46; As mentioned previously&#44; healthcare expenditure in the first year after stroke in our study is consistent with estimates from a previous study conducted in our setting<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#59; furthermore&#44; the mortality rate observed in our sample is similar to those reported by specific studies&#44;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a> which supports the validity of administrative data for these purposes&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">However&#44; the use of administrative data is not without limitations&#46; Although registries undergo regular quality controls&#44; the presence of coding errors cannot be ruled out&#46; Furthermore&#44; administrative databases do not gather data on stroke severity or sequelae&#59; resource use as a function of these variables cannot therefore be analysed&#46; Future studies may address this limitation by combining administrative data with clinical data from the stroke registries implemented in Catalonia in recent years<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a>&#59; such registries may also be expanded to cover the whole Spanish population with the development of initiatives similar to the Sentinel Stroke National Audit Programme&#44; which gathers data from England&#44; Wales&#44; and Northern Ireland&#46; Our results cannot be extrapolated to other settings since resource costs may vary considerably between healthcare systems&#44;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#44;19</span></a> potentially resulting in substantial differences in the costs associated with ischaemic stroke between countries &#40;ranging from &#36;2822 in Eastern European countries to &#36;22 377 in the United Kingdom&#41;&#44; or even between regions within the same country &#40;&#36;7309 vs &#36;146 149 in the United States&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> However&#44; data on resource use&#44; the magnitude of incremental costs&#44; and the percentage of these costs attributable to the use of each resource may be extrapolated to other countries with similar healthcare systems &#40;public&#44; free to use&#44; and universal&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In conclusion&#44; increased healthcare expenditure after ischaemic stroke is mainly explained by the initial need for hospitalisation&#44; with costs decreasing a year after stroke but remaining higher than baseline levels&#46; Information from population databases may be valuable for generating hypotheses for clinical studies and for improving the organisation of stroke care&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Author contributions</span><p id="par0175" class="elsevierStylePara elsevierViewall">A&#46; Ribera participated in study conception and design and in data interpretation&#44; and drafted the first version of the manuscript&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">E&#46; Vela and M&#46; Cl&#232;ries participated in study conception and design and in data analysis and interpretation&#44; and critically reviewed the manuscript&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">A&#46; Garc&#237;a-Alt&#233;s and S&#46; Abilleira participated in study conception and design and in data interpretation&#44; and critically reviewed the manuscript&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">All authors approved the final version of the manuscript and take full responsibility for the accuracy and integrity of the data presented in the study&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Funding</span><p id="par0195" class="elsevierStylePara elsevierViewall">This study has received no funding&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Despite improved survival rates&#44; stroke represents an increasing healthcare and socioeconomic burden&#46; We describe the main characteristics of patients with ischaemic stroke and resource use and associated expenditure one year before and 3 years after stroke&#44; using a population-based dataset&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">The information technology systems of the Catalan Health Service were used to identify patients with ischaemic strokes occurring between January 2012 and December 2016&#46; For each patient&#44; information from one year before the stroke and up to 3 years thereafter was linked across databases&#46; We describe annual and monthly resource use and healthcare expenditure per patient&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">We identified 36 044 patients with ischaemic stroke &#40;mean age&#44; 74&#46;7&#160;&#177;&#160;13&#46;3 years&#41;&#46; The survival rate at 3 years was 63&#37;&#46; Average expenditure per patient was &#8364;3230 the year before stroke&#44; &#8364;11 060 for year 1 after stroke&#44; &#8364;4104 for year 2&#44; and &#8364;3878 for year 3&#46; The greatest determinants of cost in year 1 were hospitalisation &#40;including initial hospitalisation&#41;&#44; representing 45&#37; of the difference in expenditure compared to the previous year&#44; and convalescence and rehabilitation services&#44; representing 33&#37; of this difference&#46; After year one&#44; the increase in expenditure was mainly determined by additional hospital admissions and drug treatment&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">After ischaemic stroke&#44; healthcare expenditure increases primarily because of initial hospitalisation&#46; After year one&#44; the expenditure decreases but remains above baseline values&#46; Information from population-based datasets is useful for improving the planning of stroke services&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introduction"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
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          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
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          3 => array:2 [
            "identificador" => "abst0020"
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      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A pesar del aumento de la supervivencia&#44; el ictus representa una carga en salud y socioecon&#243;mica creciente&#46; Mediante el uso de bases de datos poblacionales describimos las caracter&#237;sticas principales de los pacientes con ictus isqu&#233;mico y comparamos el uso de recursos y el gasto asociado un a&#241;o antes y 3 a&#241;os despu&#233;s del evento&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Se identificaron en los sistemas de Informaci&#243;n del Servicio Catal&#225;n de la Salud todos los pacientes con ictus isqu&#233;mico entre los a&#241;os 2012 y 2016&#46; Se relacionaron todos los contactos con el sistema sanitario desde un a&#241;o antes del episodio &#237;ndice hasta 3 a&#241;os despu&#233;s&#46; Se describi&#243; el uso de recursos y el gasto sanitario mensual y anual por paciente en los distintos recursos&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Se identificaron 36&#46;044 pacientes con ictus isqu&#233;mico&#44; edad media &#40;DE&#41; de 74&#44;7 &#40;13&#44;3&#41; a&#241;os&#46; La supervivencia a los 3 a&#241;os fue del 63&#37;&#46; El gasto medio por paciente en el a&#241;o previo fue de 3&#46;230&#8364;&#44; de 11&#46;060&#8364; el primer a&#241;o desde el ictus&#44; de 4&#46;104&#8364; el segundo y 3&#46;878&#8364; el tercero&#46; Los mayores determinantes de gasto en el primer a&#241;o fueron las hospitalizaciones &#40;incluyendo la hospitalizaci&#243;n inicial&#41;&#44; representando el 45&#37; de la diferencia con respecto al a&#241;o previo al ictus&#44; y en segundo lugar el gasto en convalecencia y rehabilitaci&#243;n &#40;un 33&#37;&#41;&#46; Despu&#233;s del primer a&#241;o&#44; los mayores determinantes del incremento en el gasto respecto al a&#241;o previo fueron las nuevas hospitalizaciones y el tratamiento farmacol&#243;gico&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusi&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Despu&#233;s de un ictus isqu&#233;mico&#44; el gasto en atenci&#243;n sanitaria aumenta principalmente por las necesidades iniciales de hospitalizaci&#243;n y despu&#233;s del primer a&#241;o se reduce&#44; aunque manteni&#233;ndose por encima de los valores previos al ictus&#46; La informaci&#243;n derivada de bases de datos poblacionales es &#250;til para mejorar la organizaci&#243;n de los servicios de atenci&#243;n al ictus&#46;</p></span>"
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            "titulo" => "Conclusi&#243;n"
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      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as&#58; Ribera A&#44; Vela E&#44; Garc&#237;a-Alt&#233;s A&#44; Cl&#232;ries M&#44; Abilleira S&#46; Evoluci&#243;n del gasto en servicios sanitarios antes y despu&#233;s del ictus isqu&#233;mico&#58; an&#225;lisis de base poblacional&#46; Neurolog&#237;a&#46; 2022&#59;37&#58;21&#8211;30&#46;</p>"
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            "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0060"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patient flow chart&#46;</p>"
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          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Population pyramid&#46;</p>"
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Survival and outcomes over the 3 years after stroke in our patient population&#46;</p>"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Mean monthly expenditure per patient during the year before stroke and the 3 years after stroke&#44; by healthcare resource&#46;</p>"
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        "identificador" => "fig0025"
        "etiqueta" => "Figure 5"
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        "figura" => array:1 [
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          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Difference between the mean annual expenditure in each of the first 3 years following stroke and in the year before stroke&#44; and percentage of expenditure attributed to each type of resource&#46;</p>"
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                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Total&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">n&#160;&#61;&#160;17 072&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44; mean &#40;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">74&#46;7 &#40;13&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">71&#46;4 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">78&#46;4 &#40;12&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Ischaemic heart disease</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6697 &#40;18&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4037 &#40;21&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2660 &#40;15&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">AHT</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">26 868 &#40;75&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13 262 &#40;70&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7126 &#40;37&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Hypercholesterolaemia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Emergency department &#40;visits&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Day hospital&#44; acute care hospital &#40;visits&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Outpatient consultations &#40;visits&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Hospital mental care</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Home hospitalisation &#40;discharges&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="8" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="8" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleBold">Long-stay hospital care and rehabilitation</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Long-stay hospital &#40;admissions&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&#46;06 &#40;10&#46;67-11&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;89 &#40;1&#46;79-2&#46;00&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>UFISS &#40;visits&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">12&#46;03 &#40;11&#46;27-12&#46;86&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;78 &#40;1&#46;62-1&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;05&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;75 &#40;1&#46;58-1&#46;94&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PADES &#40;visits&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">4&#46;48 &#40;3&#46;88-5&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;31 &#40;1&#46;95-2&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;01&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;04 &#40;1&#46;67-2&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Long-stay day hospital &#40;visits&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#46;21 &#40;10&#46;73-11&#46;71&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;96 &#40;7&#46;60-8&#46;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&#46;72 &#40;7&#46;35-8&#46;11&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Rehabilitation &#40;sessions&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9&#46;81 &#40;9&#46;42-10&#46;23&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#46;27 &#40;3&#46;12-3&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;06 &#40;1&#46;94-2&#46;19&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Non-emergency medical transport &#40;transfers&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;37&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6&#46;32&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#46;62 &#40;4&#46;57-4&#46;66&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;82 &#40;1&#46;80-1&#46;85&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;00&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;46 &#40;1&#46;44-1&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Outpatient care</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Primary care &#40;visits&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&#46;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">22&#46;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;47 &#40;1&#46;46-1&#46;47&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18&#46;24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;18 &#40;1&#46;17-1&#46;18&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">17&#46;76&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;14 &#40;1&#46;14-1&#46;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Outpatient mental health care</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;09&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;39 &#40;1&#46;33-1&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;38 &#40;1&#46;31-1&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&#46;19 &#40;1&#46;12-1&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_colgroup " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead colgroup " colspan="8" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleBold">Pharmacological treatment &#40;no&#46; packages dispensed&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>All drugs</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&#46;56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">13&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">1&#46;24 &#40;1&#46;24-1&#46;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&#46;98&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;13 &#40;1&#46;13-1&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&#46;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;15 &#40;1&#46;14-1&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Antithrombotics</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&#46;52&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11&#46;40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#46;07 &#40;2&#46;05-2&#46;08&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&#46;59&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vitamin K antagonists&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Direct oral anticoagulants&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Beta blockers</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic"><span class="elsevierStyleHsp" style=""></span>Antidepressants</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;35 &#40;1&#46;34-1&#46;36&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;46 &#40;1&#46;45-1&#46;48&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#46;31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;44 &#40;1&#46;42-1&#46;46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2809224.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Resource use &#40;units&#47;patient-year&#41; one year before and up to 3 years after ischaemic stroke&#46;</p>"
        ]
      ]
      7 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0040"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">1 year before stroke&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">1 year after stroke&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Incremental cost&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">2 years after stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Incremental cost&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">3 years after stroke&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">Incremental cost&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#160;&#61;&#160;36 044&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#160;&#61;&#160;32 850&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#160;&#61;&#160;21 229&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#40;n&#160;&#61;&#160;14 419&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hospital care&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">924&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4434&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3509&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">239&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1097&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">175&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Neuroradiology department&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">686&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">669&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Emergency department&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">363&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">235&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">149&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Day hospital &#40;acute care&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">88&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Outpatient consultations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">220&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">392&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">171&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">289&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">265&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">45&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total cost of hospital care</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1360&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6055&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4694&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1722&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">362&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1604&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">243&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Long-stay hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">163&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2452&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2289&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">312&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">148&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">265&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Day hospital &#40;long-term care&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">102&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">225&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">123&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">107&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">121&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Rehabilitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">157&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">140&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">39&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-emergency medical transport&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">33&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">151&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">58&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total cost of long-term care and rehabilitation</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">316&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2670&#46;5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">470&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Primary care</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">478&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">204&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">531&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">499&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total cost of pharmacological treatment</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">897&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">259&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1147&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">249&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Other<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">178&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">168&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;9&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">150&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;27&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Total cost per patient</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3230&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 059&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7829&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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Article information
ISSN: 21735808
Original language: English
DOI:10.1016/j.nrleng.2018.11.010
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