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Published on: August 11, 2015
Initial and subsequent 3-year cost after hospitalization for first acute ischemic stroke and intracerebral hemorrhage
Mohammed Yousufuddin1, James P Moriarty2, Kandace A Lackore2
1Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Insights
The cost of acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH) care is substantial, with lost productivity being the largest expense. Factors like age, race, and comorbidities significantly impact stroke treatment costs.
Area of Science:
- Neurology
- Health Economics
- Public Health
Background:
- Stroke, encompassing acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH), represents a significant global health burden.
- Understanding the economic impact of stroke is crucial for healthcare planning and resource allocation.
- Previous studies have often focused on acute care costs, with less emphasis on long-term follow-up and indirect economic consequences.
Purpose of the Study:
- To determine the primary factors influencing hospitalization and 3-year post-acute care costs for AIS and ICH.
- To quantify the direct costs associated with rehabilitation and home healthcare following stroke.
- To estimate the indirect costs stemming from lost productivity in patients after AIS and ICH.
Main Methods:
- A retrospective analysis was conducted on adult patients hospitalized with AIS (n=811) and ICH (n=145) between 2003 and 2014.
- Direct costs for hospitalization and 3-year follow-up were standardized to Medicare reimbursement rates.
- Generalized linear modeling with a gamma distribution was used for adjusted cost estimations, supplemented by literature review for rehabilitation, homecare, and lost productivity costs.
Main Results:
- Mean hospitalization costs were $18,154 for AIS and $24,077 for ICH. Three-year aggregate costs were $5,138/month for AIS and $8,172/month for ICH.
- Indirect costs from lost productivity were substantial: $77,078 for AIS and $56,601 for ICH.
- Younger age (<55 years), non-white ethnicity, and stroke severity were linked to higher hospitalization costs. Comorbidities like cancer, heart failure, and COPD increased long-term costs for AIS, while cancer and diabetes elevated costs for ICH.
Conclusions:
- This study provides comprehensive estimates of direct and indirect costs for acute and post-acute care over three years following AIS and ICH.
- Key predictors for hospitalization and 3-year post-stroke costs were identified, offering insights for targeted interventions.
- The findings highlight the significant economic burden of stroke, emphasizing the need for effective management strategies to mitigate both direct and indirect financial impacts.
Aims:
To examine 1) the major drivers of index hospitalization and 3-year post-acute follow-up care, 2) cost for rehabilitation and homecare, and 3) indirect cost from lost productivity after acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH).
Methods:
Retrospective study of adults hospitalized with AIS (n = 811) and ICH (N = 145) between 2003 and 2014. Direct costs standardized to Medicare reimbursement rates were captured for hospitalization and 3-year follow-up or death. Adjusted cost estimates were assessed using generalized linear modeling with gamma distribution. Costs for rehabilitation, home healthcare, and lost productivity were assessed using sets of cost captured through literature review.
Results:
Calculated as mean cost per person: hospitalization $18,154 for AIS and $24,077 for ICH; monthly 3-year aggregate $5138 for AIS and $8172 for ICH; 3-year inpatient rehabilitation $4185 for AIS and $4196 for ICH; homecare $19,728 for AIS and $14,487 for ICH; indirect cost from lost productivity $77,078 for AIS and $56,601 for ICH. Age < 55 years, being non-white, and stroke severity were strongly associated with greater hospitalization cost for AIS and ICH. Hyperlipidemia incurred lower while cancer, coronary artery disease, asthma/chronic obstructive pulmonary disease, heart failure, and anemia incurred higher 3-year aggregate cost for AIS. Cancer and diabetes mellitus incurred higher 3-year aggregate cost for ICH.
Conclusions:
We provide estimates of direct and indirect costs incurred for acute and continuing post-acute care through a 3-year follow-up period after first-ever AIS and ICH with important comparisons for predictors between index hospitalization and 3-year post-stroke costs.
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