Costs of Stroke Using Patient-Level Data

Abstract

Background and Purpose-With decision-analytic models becoming more popular to assess the cost-effectiveness of health care interventions, the need for robust estimates on the costs of cerebrovascular disease is paramount. This study reports the results from a literature review of the costs of cerebrovascular diseases, and assesses the quality of the published evidence against a set of defined criteria. Methods-A broad literature search was conducted. Those studies reporting mean/median costs of cerebrovascular diseases derived from patient-level data in a developed country setting were included. Data were abstracted using standardized reporting forms and assessed against 4 predefined criteria: use of adequate methodologies, use of a population-based study, inclusion of premorbid resource use, and reporting of costs by different patient subgroups. Results-A total of 120 cost studies were identified. The cost estimates of stroke were compared by taking into account the effects of inflation and price differentials between countries. Average costs of stroke ranged from $468 to $146 149. Differences in costs were also found within country, with estimates in the USA varying 20-fold. Although the costing methodologies used were generally appropriate, only 5 studies were based on population-based studies, which are the gold standard study design when comparing incidence, outcome, and costs. Conclusions-This review showed large variations in the costs of stroke, mainly attributable to differences in the populations studied, methods, and cost categories included. The wide range of cost estimates could lead to selection bias in secondary health economic analyses, with authors including those costs that are more likely to produce the desired results. (Stroke. 2009;40:e18-e23.)

The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort

“…Childhood stroke was even more costly, with an average 5-year-total of $135,000, and a maximum approaching $1 million. Although few adult studies have measured costs beyond the first year poststroke, 26 available data suggest that, during a similar time window, childhood stroke may be more costly than stroke in adults. For strokes diagnosed in US Medicare beneficiaries (age Ն65 years) in 1997, average Medicare expenditures at 4 years poststroke were $48,327 for subarachnoid hemorrhage, $38,023 for intracerebral hemorrhage, and $39,396 for ischemic stroke.…”

Individual and Regional‐level Factors Contributing to Variation in Length of Stay After Cerebral Infarction in Six European Countries

“…In addition to affecting the lives of the people suffering a cerebral infarction, it has a major impact on healthcare expenditure (Evers et al, 2004). The costs in the treatment of cerebral infarction mostly stem from inpatient care (Cadilhac et al, 2009;Rossnagel et al, 2005); the hospital costs have been shown to vary enormously (Luengo-Fernandez et al, 2009). …”

Impact of Disability Status on Ischemic Stroke Costs in Canada in the First Year

“…The life time cost of stroke to society has been estimated to be $ 20.6 billion (1990) 6 . A review of economic studies shows a wide range of per-patient costs from $468 to $146,149 ($US) with few studies examining costs after hospital discharge 7 . Costs by severity of disease are critical to decision makers when evaluating new treatments.…”