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Hospitalization costs in patients with stroke in southeastern China: a retrospective population-based cohort study,
Jing Xu1, Ruixue Ye1, Jingpu Zhao1
1Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital, Shenzhen University School of Medicine, Shenzhen, Guangdong, China.
Insights
Stroke care costs are substantial, with hemorrhagic strokes being more expensive than ischemic strokes. Key factors influencing costs include length of stay and hospital type, necessitating targeted interventions to reduce the economic burden.
Area of Science:
- Health Economics
- Neurology
- Public Health
Background:
- Stroke is a leading cause of death and disability globally.
- Rising healthcare expenditures associated with stroke present a significant societal challenge.
- Previous research has insufficiently examined the economic impact of stroke, particularly across different subtypes.
Purpose of the Study:
- To analyze in-hospital stroke costs across various stroke subtypes.
- To identify key factors influencing stroke-related hospitalization expenses.
- To provide insights for mitigating the economic burden of stroke care.
Main Methods:
- Retrospective analysis of stroke patient records from 50 hospitals in southeastern China (2019-2022).
- Multistage stratified cluster random sampling was employed for patient selection.
- Multivariate linear regression was used to determine cost determinants.
Main Results:
- Subarachnoid hemorrhage (SAH) incurred the highest costs, followed by intracerebral hemorrhage (ICH), ischemic stroke (IS), and transient ischemic attack (TIA).
- Length of stay (LOS), stroke subtype, and hospital level were significant determinants of hospitalization costs.
- Cost composition varied by stroke type, with therapy fees prominent in ICH and IS, and materials in SAH.
Conclusions:
- Hospitalization costs for stroke are significantly influenced by stroke subtype and hospital characteristics.
- Hemorrhagic strokes are more costly than ischemic strokes.
- Strategies such as enhancing insurance for hemorrhagic strokes, implementing hierarchical care, and reducing LOS are recommended to alleviate economic burdens.
Introduction:
Stroke remains a predominant cause of mortality and accounts for one-third of all stroke-related fatalities worldwide. Increasing expenses associated with stroke are a matter of significant concern; however, this aspect has been insufficiently examined.
Methods:
The purpose of this study was to analyze in-hospital stroke costs and explore potential factors influencing them across stroke subtypes. The records of stroke patients from 50 hospitals in southeastern China between 2019 and 2022 were reviewed using multistage stratified cluster random sampling. We focused on the cost patterns of four stroke types and used multivariate linear regression to identify cost determinants.
Results:
A total of 417 (1.1%) patients had subarachnoid hemorrhage (SAH), 9309 (25.9%) had intracerebral hemorrhage (ICH), 22,248 (61.8%) had ischemic stroke (IS), and 4025 had transient ischemic attack (TIA). The number of stroke patients has sharply increased since the onset of COVID-19, with a majority of them being male (72.2%). Despite the fact that hospitalization costs are highest in tertiary hospitals (Chinese yuan [CNY] 30610.8/United States dollar [USD] 4551.0, interquartile range [IQR] 9944.9, 29668.4/1478.6, 4410.9), the majority of patients are admitted to tertiary hospitals (74.6%) or public hospitals (90.2%). Across all stroke subtypes, patients with SAH had the highest costs (CNY 93,454.9/USD13894.4, IQR 12273.2, 169920.0/1824.7, 25262.8), followed by those with ICH (CNY 48,724.2/USD 7244.0, IQR 16789.6, 57540.7/2496.2, 8554.8), IS (CNY 26,550.3/USD3947.4, IQR 8684.2, 28697.7/1291.1, 4266.6), and TIA (CNY 11,170.1/USD1660.7, IQR 6823.7, 12965.2/1014.5, 1927.6). Therapy fees comprised a significant portion of costs in ICH and IS cases (47.9% and 42.7%, respectively). Materials accounted for the highest proportion of expenses for SAH (56.1%), whereas patients with TIA spent more time on examinations (34.1%). Linear regression analysis revealed that length of stay (LOS), stroke subtype, hospital level, and stroke type were key factors influencing hospitalization costs.
Discussion:
The visiting rate and charges were highest in tertiary public hospitals, and hospitalization costs were higher in hemorrhagic types of stroke than in ischemic types of stroke; the proportion of hospitalization cost categories varied among different types of stroke, with LOS, hospital type, and level substantially affecting hospitalization costs. Enhancing medical insurance reimbursement rates for hemorrhagic strokes, implementing a hierarchical medical system, tailoring cost categories to accommodate varying stroke subtypes, and shortening LOS may help alleviate the economic burden of stroke.
