Hospital treatment costs and length of stay associated with hypertension and multimorbidity after hemorrhagic stroke

Abstract

BackgroundPrevious studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke. Patient morbidity is perhaps the least understood of these cost-driving factors. We describe how hypertension and other patient morbidities affect length of stay, and hospital treatment costs after ICH using primary and simulated data. We also describe the relationship between cost and length of stay within these patients.MethodsWe used a cohort design; evaluating 987 consecutive ICH patients across one decade in a Canadian center. Economic, treatment, and patient data were obtained from clinical and administrative sources. Multimorbidity was defined as the presence of one or more diagnoses at hospital admission in addition to a primary diagnosis of ICH.ResultsHypertension was the most frequent (67%) morbidity within these patients, as well as the strongest predictor of longer stay (adjusted RR for >7 days: 1.31, 95% CI: 1.07-1.60), and was significantly associated with higher cost per visit when accounting for other morbidities (adjusted cost increase for hypertension $8123.51, 95% CI: $4088.47 to $12,856.72 USD). A Monte Carlo simulation drawing one million samples of patients estimated for a generation (100 years) assuming 0.94% population growth per year, and a hospitalization rate of 12 per 100,000 inhabitants, supported these findings (p = 0.516 for the difference in unadjusted cost: simulated vs primary). Using a restricted cubic spline, we observed that the rate of change in overall cost for all patients was greatest for the first 3 weeks (p < 0.001) compared to subsequent weeks.ConclusionPatient multimorbidity, specifically hypertension, is a strong predictor of longer stay and cost after ICH. The non-linear relationship between cost and time should also be considered when forecasting healthcare spending in these patients.

The cost of stroke in a public hospital in Brazil: a one-year prospective study

“…However, in both studies, the samples were very small (2/31 in Joinville and 6/45 in São Paulo). A recent cohort study 31 , conducted in Canada on the median cost for 987 patients with PIH, reported that the median cost ranged from US$4,685 (2,196) to US$8,867 (3,612).…”

Multimorbidity in Stroke

“…There were 13 conditions in addition to stroke examined and no explanation was given from the authors as to why they were chosen. Hypertension was the most prevalent comorbidity and independent of all other long-term conditions studied, it was most strongly associated with having a longer stay, and alongside cerebrovascular disease, was linked to the highest overall cost of stay 33 In a study of approximately 2,200 stroke survivors in Germany, previous stroke, diabetes, symptoms of internal carotid artery stenosis , or a count of >3 comorbidities, were all associated with insurance applications for long-term nursing care within 3.6 years of their stroke 34 . There were 9 conditions chosen for examination and again no reason was given for their selection.…”

“…A small Canadian cohort study using clinical and administrative data collected in one hospital over a decade (N=987), showed that having at least one other comorbidity was related to a longer (>7 days) hospital stay for those with a haemorrhagic stroke. This resulted in costlier care, through both diagnostic and rehabilitation stages of care 33 . There were 13 conditions in addition to stroke examined and no explanation was given from the authors as to why they were chosen.…”

Exploring racial/ethnic disparities in hypertension care among patients served by health centers in the United States

“…For example, hypertension consistently ranks as one of the primary reasons to visit a doctor . Hypertension‐related emergency department (ED) visits are also rising, and patients with hypertension have longer hospital stays and incur greater costs …”

“…8 Hypertension-related emergency department (ED) visits are also rising, and patients with hypertension have longer hospital stays and incur greater costs. 9,10 Hypertension takes on further national significance as its burden and impact is unequally distributed across the nation's populations. 11,12 Racial and ethnic minorities, particularly African Americans, have higher rates of hypertension morbidity and mortality Some racial/ethnic minorities are more likely to have hypertension and experience increased hypertension-related morbidity and mortality compared to whites.…”