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Updated: Jan 27, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Heterogeneity in costs and prognosis for acute ischemic stroke treatment by comorbidities
Euna Han1, Tae Hyun Kim2, Heejo Koo1
1College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea.
Insights
Patients with severe comorbidities after acute ischemic stroke face a poorer prognosis and significantly higher healthcare costs. Understanding comorbidity levels is vital for predicting outcomes and managing expenses in stroke care.
Area of Science:
- Neurology
- Health Economics
- Public Health
Background:
- Comorbidities are common in patients experiencing acute ischemic stroke.
- Existing research indicates a link between comorbidities and stroke outcomes, but cost variations require further investigation.
Purpose of the Study:
- To assess how concurrent comorbidities influence the cost and prognosis of acute ischemic stroke.
- To quantify the excess healthcare costs associated with different levels of comorbidity in stroke patients.
Main Methods:
- Utilized the Charlson comorbidity index to categorize patients into none, mild, moderate, and severe comorbidity groups.
- Analyzed outcomes including modified Rankin Scale (mRS) scores, 1-year mortality, and stroke recurrence.
- Employed multivariate log-normal and Cox proportional hazards models for cost and outcome analysis, respectively.
Main Results:
- Patients with severe comorbidities had significantly lower chances of good functional outcomes (mRS ≤ 2) and higher mortality rates within 3 months.
- The severe comorbidity group exhibited substantially increased risks of death and stroke recurrence within 1 year.
- Incremental costs were notably higher for severe comorbidity groups, reaching $7074 USD at 1 year compared to $1265 USD for the mild group.
Conclusions:
- Severe comorbidities are associated with poor stroke prognosis and elevated healthcare expenditures.
- The cost-effectiveness of improving short-term prognosis is lowest in patients with severe comorbidities.
- Stratifying patients by comorbidity level is essential for accurate outcome prediction and managing healthcare costs in acute ischemic stroke.
Objective:
Comorbidities are prevalent among stroke patients. The current study assesses the variations in cost and stroke prognosis by concurrent comorbidities in patients with acute ischemic stroke.
Methods:
The Charlson comorbidity index was used as the composite comorbidity level (0 none, 1 mild, 2 moderate, and ≥ 3 severe). Outcomes included modified Rankin Scale (mRS) at 3 months and 1-year mortality and stroke recurrence. We utilized a multivariate log-normal model for cost, a proportional Cox hazards model for outcomes, and a decision analytic model for the excess cost per unit change in outcome probability compared with the no-comorbidity group.
Results:
A total of 3605 consecutive patients were enrolled. At 3 months, the severe comorbidity group was 0.32 times less likely to have mRS ≤ 2, and were 4.86 times more likely to die from stroke than the no-comorbidity group. Within 1 year, the severe comorbidity group showed 10.36 and 3.38 times higher likelihoods of death from stroke and stroke recurrence than the no-comorbidity group. The incremental cost was 4376 in 3 months and 7074 USD in 1 year for the severe comorbidity group, and 985 in 3 months and 1265 USD in 1 year for the mild comorbidity group compared to the no-comorbidity group.
Conclusion:
The excess cost per unit increase of a short-term good prognosis was largest for the severe comorbidity group. Patients with severe comorbidities showed poor prognosis and large health expenditure. Assessing comorbidity level is crucial for better prediction of outcomes and excess cost.
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