Costs of stroke care according to handicap levels and stroke subtypes

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.

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.

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.

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.