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

Abstract

Background: Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs. Methodology: The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): nondisabling stroke (mRS 0-2) and disabling stroke (mRS 3-5). Results: We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes. Conclusions: An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A "back of the envelope" calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.RÉSUMÉ: Impact du degré d'invalidité sur les coûts reliés à l'accident vasculaire cérébral ischémique au cours de la première année au Canada. Contexte : Nous n'avons pas de données longitudinales sur l'utilisation des ressources par les patients et les coûts ainsi engendrés suite à un accident vasculaire cérébral (AVC) ischémique au Canada. Les buts de cette analyse étaient de calculer les coûts engendrés au cours de la première année après un AVC et de déterminer l'impact de l'invalidité sur ces coûts. Méthode : Le Economic Burden of Ischemic Stroke (BURST) Study est une étude prospective d'une durée de un an chez une cohorte de patients ayant subi un AVC ischémique qui ont été recrutés dans 12 centres canadiens de traitement de l'AVC. Des informations ont été recueillies sur l'histoire clinique, l'invalidité, les choix de santé et l'utilisation des ressources au moment du congé hospitalier, trois mois, six mois et un an plus tard. Les ressources incluaient les coûts médicaux directs (en $ canadiens 2009) comme les services d'urgence, les hospitalisations, la réadaptation, les frais médicaux, diagnostiques et thérapeutiques, les autres services professionnels, les soins à domicile, les équipements médicaux/accessoires fonctionnels, les changements effectués au lieu de résidence et les aidants rémunérés ainsi que les ...

Mechanical thrombectomy in patients with acute ischemic stroke: a cost-utility analysis

“…Costs for stroke were based on the Economic Burden of Ischemic Stroke study 29 and are expressed in April 2015 Canadian dollars. 34 The Economic Burden of Ischemic Stroke study was a prospective cohort study involving patients with ischemic stroke in 12 Canadian stroke centres.…”

“…They also divided costs into direct (e.g., emergency services, hospitalization, rehabilitation, physician services, diagnostics, medications) and indirect (e.g., productivity loss and resource use for unpaid caregivers) costs. We considered direct costs from the Economic Burden of Ischemic Stroke study 29 in the base case analysis. We did not include stroke recurrence as a separate event in our model, but the health care costs of recurrence were accounted for in the cost estimates.…”

“…*Given the odds ratio of 2.39 and pooled proportion of functional independence of 0.2874, we estimated that the proportion of functional independence was 0.4908. †Economic Burden of Ischemic Stroke study 29 did not report the 95% CI or standard error (SE) of their cost estimates. We assumed the SE was equal to 20% of the mean in the probabilistic sensitivity analysis.…”

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“…The direct costs for hospitalization and readmissions for patients having minor and major strokes were based on the findings of the multicenter Canadian Burden of Ischemic Stroke (BURST) study. 16 For the base case analysis, only direct costs for patients with major and minor strokes were used (Table 2). These included costs for hospitalizations, rehabilitation, diagnostic imaging, medications, physician services, home care, changes of residence, and paid caregivers.…”

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