Costs of Stroke Care according to Handicap Levels and Stroke Subtypes

Abstract

Background: If new advances in stroke management are to be put into practice, crucial information about their costs needs to be considered in relation to clinically pertinent variables (e.g. handicap level and stroke subtypes). Details of costs throughout the entire period of stroke care are essential in the political decision-making process, in order to avoid other budget-balancing approaches, which are not always satisfactory. Our aim was to perform an in-depth evaluation of the direct medical cost of stroke care in a large cohort. Methods: We included 435 consecutive patients with brain infarction in 12 primary-care and referral neurology departments. Information on acute care was prospectively collected. Information on postacute care was collected by research nurses’ visits to the patient’s or a relative’s home 18–40 months after the stroke onset. We thus collected detailed information on handicap levels, stroke subtypes, acute hospitalization costs, rehabilitation, nursing care and ambulatory costs. This enabled us to calculate costs over an 18-month period after the initial acute hospital discharge. Results: By the 12th month after discharge, the costs amounted to 17,799 euros (16,440–19,158) per patient; the initial hospitalization accounted for 42% of this cost, rehabilitation for 29% and ambulatory care for 8%. These costs were mostly concentrated within the first 3- to 6-month period. After 46 months without recurrence, the cost of ambulatory care outweighed the cost of the first 6 months. Handicap levels explained 43% of the variance of costs (p < 0.0001) and, according to the Rankin scale divided into 3 classes (0–2, 3 and 4–5), cumulative costs over time differed considerably. Stroke subtypes were not discriminating variables except for lacunar strokes, which were significantly less costly than the other groups. Conclusions: By providing a fairly comprehensive figure for the details of direct costs of stroke care over time, our study gives some clues about the economic burden of stroke care which is mostly driven by a high handicap level. This suggests that any early intervention aimed at reducing the handicap level will probably dramatically reduce this burden.

Early Supported Discharge for Stroke Patients Improves Clinical Outcome. Does It Also Reduce Use of Health Services and Costs?

“…Tariffs were used for a variety of home-based rehabilitation services, where detailed cost data were not available. The present approach is similar to that of Spieler et al [17]; however, an important difference is that they use average cost per stay and thus allocate the same hospital costs to patients with either short or long lengths of stay. In this respect, we believe that the present approach better captures the real use of hospital resources.…”

Contemporary Outcome Measures in Acute Stroke Research

“…In a relatively small number of patients (nϭ435), Spieler et al 56 found that by month 12 after discharge, the costs of stroke care amounted to 17 799 euros (16 440 -19 158) per patient; the initial hospitalization accounted for 42% of this cost, rehabilitation accounted for 29%, and ambulatory care accounted for 8%. These costs were mostly concentrated within the first 3-to 6-month period.…”

Association Between Disability Measures and Healthcare Costs After Initial Treatment for Acute Stroke

“…11 Higher economic costs have been associated with higher disability levels on discharge as measured by the Rankin scale. [12][13][14] However, analyses have been dichotomized and based on crude splits in mRs score disregarding information about any difference in costs associated with Rankin categories 0 to 1 and 3 to 4 for example. Furthermore, the time of Rankin assessment in these studies was typically at discharge rather than after a predetermined interval, biasing the estimates and rendering extrapolation to trial data difficult.…”