The One-Year Attributable Cost of Poststroke Aphasia

Abstract

Background and Purpose Little is known about the contribution of aphasia to the cost of care for patients who experience stroke. Methods We retrospectively examined a cohort of South Carolina Medicare beneficiaries who experienced an ischemic stroke in 2004 to determine the attributable cost of aphasia. Univariate analyses were used to compare demographic, comorbidity, and severity differences between individuals with post-stroke aphasia and those without aphasia. Differences in payments by Medicare due to stroke were examined using a Gamma distributed generalized linear multivariable model. Results 3,200 Medicare beneficiaries experienced an ischemic stroke in South Carolina in 2004 and 398 had post-stroke aphasia. Patients with aphasia experienced longer length of stays, greater morbidity, and greater mortality. In adjusted models that controlled for relevant covariates, the attributable one-year cost of aphasia was estimated at $1703. Conclusions Aphasia adds to the cost of stroke-related care, above the cost of stroke alone.

Effect of aphasia on acute stroke outcomes

“…These data suggest that further research is necessary to determine whether establishing adaptive communication skills can mitigate its consequences in the acute stroke setting. Neurology ® 2016;87:2348-2354 GLOSSARY CI 5 confidence interval; LOS 5 length of stay; mRS 5 modified Rankin Scale; NIHSS 5 NIH Stroke Scale; OR 5 odds ratio.Stroke is the leading cause of disability in the United States.1 Among its most devastating manifestations is aphasia, affecting 21%-38% of acute stroke patients, 2 of which 80% arise from an ischemic event.3 Poststroke aphasia has higher attributable costs of care after discharge compared to stroke without aphasia, 4 and results in a higher rate of stroke recurrence, believed to be related to failure to understand treatment regimens or to communicate symptoms. [5][6][7] Little is known, however, about how aphasia affects outcomes during the acute stroke admission.…”

“…1 Among its most devastating manifestations is aphasia, affecting 21%-38% of acute stroke patients, 2 of which 80% arise from an ischemic event. 3 Poststroke aphasia has higher attributable costs of care after discharge compared to stroke without aphasia, 4 and results in a higher rate of stroke recurrence, believed to be related to failure to understand treatment regimens or to communicate symptoms. [5][6][7] Little is known, however, about how aphasia affects outcomes during the acute stroke admission.…”

“…Others have reported increased LOS among those with Table 2 Associations between aphasia, hemiparesis, and outcomes Aphasia and hemiparesis defined as a score of 1 or more Aphasia and hemiparesis defined as a score of 2 or more aphasia, but one study used billing codes and a nonstandardized and a nonvalidated proxy for aphasia, which likely resulted in underreporting (12%) of cases. 4 In another study, patients who were discharged within 7 days after admission with aphasia were excluded.…”

“Communication is taking a back seat”: An exploration of aphasia management in acute hospital settings

“…If we drill down to look more specifically at the direct rehabilitation costs in the year following first ever stroke in Australia, estimates in 2009 placed the cost at $248 million (Cadilhac, Carter, Thrift, & Dewey, 2009). Given that approximately one third of stroke survivors have aphasia (Dickey et al, 2010), we can estimate from this that at least one third of costs -or $83 million -would be accredited to people with aphasia; however, given that findings likely indicate that aphasia adds to the cost of stroke-related care, above the cost of stroke alone, this estimate is likely to be conservative (Ellis, Simpson, Bonilha, Mauldin, & Simpson, 2012). Identifying management approaches which aim to effectively and efficiently minimise negative outcomes of aphasia following stroke in order to prevent unwarranted healthcare spending should undoubtedly be a priority.…”

“…The presence of aphasia is an independent predictor of increased length of hospital stay and increased use of rehabilitation services (Dickey et al, 2010). The presence of aphasia, therefore, has likely associated financial ramifications for the healthcare system (Ellis et al, 2012).…”