Acute ischemic stroke in a university hospital intensive care unit: 1-year costs and outcome

Little is currently known about the cost-effectiveness of intensive care of acute ischemic stroke (AIS). We evaluated 1-year costs and outcome for patients with AIS treated in the intensive care unit (ICU).

A single-center retrospective study of patients admitted to an academic ICU with AIS between 2003 and 2013. True healthcare expenditure was obtained up to 1 year after admission and adjusted to consumer price index of 2019. Patient outcome was 12-month functional outcome and mortality. We used multivariate logistic regression analysis to identify independent predictors of favorable outcomes and linear regression analysis to assess factors associated with costs. We calculated the effective cost per survivor (ECPS) and effective cost per favorable outcome (ECPFO).

The study population comprised 154 patients. Reasons for ICU admission were: decreased consciousness level (47%) and need for respiratory support (40%). There were 68 (44%) 1 year survivors, of which 27 (18%) had a favorable outcome. High age (odds ratio [OR] 0.95, 95% confidence interval [CI] 0.91-0.98) and high hospital admission National Institutes of Health Stroke Scale score (OR 0.92, 95% CI 0.87-0.97) were independent predictors of poor outcomes. Increased age had a cost ratio of 0.98 (95% CI 0.97-0.99) per added year. The ECPS and ECPFO were 115,628€ and 291,210€, respectively.

Treatment of AIS in the ICU is resource-intense, and in an era predating mechanical thrombectomy the outcome is often poor, suggesting a need for further research into cost-efficacy of ICU care for AIS patients.