Ninety-Day Cost, Mortality and Hospital Disparities in Ischemic Stroke: Real-World Evidence from a Czech...

Background: Stroke remains a significant health and economic challenge both globally and in the Czech Republic. Although a structured network of specialized stroke centres exists, comparative data on patient outcomes and healthcare costs across hospital types are still lacking in the Czech context. This study analyzed real-world administrative data to assess 90-day mortality and healthcare costs after ischemic stroke, categorized by intervention and provider type. Methods: Claims data from six Czech health insurance companies, covering approximately 44% of the population, were used for the years 2017-2020. Patients aged 18 and older with a primary diagnosis of ischemic stroke (ICD-10 code I63) were included. Interventions were categorized as thrombectomy, thrombolysis, or other treatment, and providers were classified as comprehensive stroke centres (CSCs), primary stroke centres (PSCs), secondary referral hospitals (SRHs), or others. Costs were calculated from the payer perspective using administrative claims data, and standardized 90-day mortality and effective cost per survivor (ECPS) were computed. Funnel plots were used to evaluate provider variability in outcomes and costs. The analysis included 23,568 patients (47% female; mean age 70.6). Results: Thrombectomy was associated with the highest mean costs (€13,385), the highest 90-day mortality (29.3%), and the highest ECPS (€18,880). Patients receiving other treatments had the lowest costs (€2725) and lower mortality (14.4%). CSCs recorded the highest average costs (€5087) and mortality (16.7%), while SRHs had the lowest costs (€2204) and mortality (13.7%). Funnel plots revealed greater variability in costs, mainly driven by primary hospitalization, while mortality rates showed less variation. Conclusions: These findings suggest that while stroke outcomes are relatively consistent across providers, costs differ, possibly reflecting efficiency differences and case-mix severity. The study is limited by the lack of clinical severity data, highlighting the need to link administrative data with clinical registries for more comprehensive future evaluations.