Dear sir, several studies have shown that stroke units and recombinant tissue plasminogen activator (rtPA) for acute ischaemic stroke are not only efficacious but also cost-effective [1, 2]. All of these studies have been conducted in developed countries. However, over 80% of all stroke deaths in the world occur in the developing countries. We propose that stroke units and thrombolysis can be even more cost-effective in low- to middle-income countries. There are few, if any intermediate or long-term rehabilitation facilities in developing countries. Stroke survivors are mainly cared by their families. Lack of organized rehabilitation care and the nonsystematic nature of care by the family can make recovery lengthier and more costly. Therefore, thrombolysis and stroke unit care could decrease the population requiring extended rehabilitation and care with the potential result of decreased health expenditure.

Less than 5% of all strokes occur in patients under 45 years of age in western countries [3]. In contrast, this proportion reaches to 18% in some developing countries [4]. The direct costs of treatment and the indirect costs of lack of productivity in young adult stroke patients impose a greater economic burden to developing countries.

Traffic jam which is a limiting factor in some developed countries is not a restricting factor in most developing countries. Eight per cent of Iranian and 14·7% of Indian stroke patients reached the hospital within the 3-hour window period, respectively [5].

As far as we know, there has been no study addressing the cost-effectiveness of stroke units and rtPA in developing countries. These studies are highly recommended.


  1. Top of page
  2. References
  • 1
    Sandercock P, Berge E, Dennis M et al. Cost-effectiveness of thrombolysis with recombinant tissue plasminogen activator for acute ischemic stroke assessed by a model based on UK NHS costs. Stroke 2004; 35:14901497.
  • 2
    Epifanov Y, Dodel R, Haacke C et al. Costs of acute stroke care on regular neurological wards: a comparison with stroke unit setting. Health Policy 2007; 81:339349.
  • 3
    Marini C, Russo T, Felzani G. Incidence of stroke in young adults: a review. Stroke Res Treat 2010; 2011:535672.
  • 4
    Hamad A, Sokrab TE, Momeni S, Mesraoua B, Lingren A. Stroke in Qatar: a one-year, hospital-based study. J Stroke Cerebrovasc Dis 2001; 10:236241.
  • 5
    Ghandehari K. Barriers of thrombolysis therapy in developing countries. Stroke Res Treat 2011; 2011:686797.