Costs of Hospitalization for Stroke Patients Aged 18-64 Years in the United States

Abstract

Background Estimates for the average cost of stroke have varied 20-fold in the United States. To provide a robust cost estimate, we conducted a comprehensive analysis of the hospitalization costs for stroke patients by diagnosis status and event type. Methods Using the 2006-2008 MarketScan inpatient database, we identified 97,374 hospitalizations with a primary or secondary diagnosis of stroke. We analyzed the costs after stratifying the hospitalizations by stroke type (hemorrhagic, ischemic, and other strokes) and diagnosis status (primary and secondary). We employed regressions to estimate the impact of event type and diagnosis status on costs while controlling for major potential confounders. Results Among the 97,374 hospitalizations (average cost: $20,396 ± $23,256), the number with ischemic, hemorrhagic, or other strokes was 62,637, 16,331, and 48,208, respectively, with these types having average costs, in turn, of $18,963 ± $21,454, $32,035 ± $32,046, and $19,248 ± $21,703. A majority (62%) of the hospitalizations had stroke listed as a secondary diagnosis only. Regression analysis found that, overall, hemorrhagic stroke cost $14,499 more than ischemic stroke (P <.001). For hospitalizations with a primary diagnosis of ischemic stroke, those with a secondary diagnosis of ischemic heart disease (IHD) had costs that were $9836 higher (P < .001) than those without IHD. Conclusions The costs of hospitalizations involving stroke are high and vary greatly by type of stroke, diagnosis status, and comorbidities. These findings should be incorporated into cost-effective strategies to reduce the impact of stroke.

Risk of Malnutrition Is an Independent Predictor of Mortality, Length of Hospital Stay, and Hospitalization Costs in Stroke Patients

“…This is a major contributor, when compared with other factors that have the potential to influence hospitalization costs after stroke. For example, it has been shown that atrial fibrillation increases acute hospitalization costs by 24% (22), depression by 63% (23), hemorrhagic strokes by 65% (vs. ischemic strokes (24)), and younger patients (18-44 years old vs. 45-64 years old) by 6% (25). Other studies that determined the hospitalization costs of nutritionally vulnerable patients report costs 20% (6) or 36% (26) higher, when compared with the costs for well-nourished patients.…”

Analysis of Hospital Charges of Inpatients with Acute Ischemic Stroke in Beijing, China, 2012–2015

“…However, Ng et al [16] studied the direct medical cost associated with stroke of 700 patients in Singapore in 2012, the mean annual direct cost of 300 patients with ischemic stroke was estimated to be USD 8,304 for inpatient services. Wang et al [17] analyzed the costs of hospitalization for stroke patients aged 18–64 years in the United States, using the 2006–2008 Market Scan in-patient database, and the average cost for 62,637 ischemic stroke patients was USD 18,963 ± 21,454. Tu et al [18] studied in-patient charges with ischemic stroke in Japan (1995–1999), and the mean (median) hospital charge per patient was USD 9,020 (7,974) with a range of USD 336–54,509.…”

Hospital Costs Associated With Atrial Fibrillation for Patients With Ischemic Stroke Aged 18–64 Years in the United States

“…Indeed, there is a need to explore AFib-associated costs for those with a secondary diagnosis of stroke because a large proportion of stroke patients have stroke listed as a secondary diagnosis. 28 Similarly, we did not include admissions with a primary diagnosis of AFib. This certainly led to a lower estimated cost associated with AFib.…”

“…32 It has been used by many researchers in estimating the economic burden of various health conditions, including cardiovascular disease. 28, 33-36 Because of the relatively low prevalence of stroke and AFib in adults younger than 65 years, we pooled 3 years of MarketScan data to increase our sample size for this analysis. In selecting the study sample (N=40,082, Figure 1), we excluded: 1) patients younger than 18 because of extremely low prevalence of stroke and AFib, and patients older than 64 because the extremely small number of these patients in this data set; 2) admissions with a capitated health insurance plan because their costs did not reflect the medical services they received; 3) missing geographic region information because region is a major controlling variable in our study; 4) hospitalizations with a cost below the 1 st or above 99 th percentiles to reduce the influence of extreme values on the cost estimates; and 5) patients with an accompanying procedure code for carotid intervention (ICD-9 procedure codes 38,02, 38.12, 00.61, 00.63) because this study focused on the cost of acute stroke rather than an elective surgical procedure.…”