In-hospital direct cost of acute ischemic and hemorrhagic stroke in Greece

Objectives – The geographic inequity and the wide variation in the patterns of care of stroke found across Europe together with the lack of health economics evaluation in Greece led to this prospective study, aiming to provide data on in‐hospital direct cost of patients with an acute stroke in Greece, and to identify independent prognostic factors. Methods – Demographic and clinical data were recorded on 429 consecutive patients with an acute ischemic or hemorrhagic stroke admitted to a tertiary care hospital in Greece during a period of 18 months. The costs incurred were estimated using the official financial charts listing in euro (€), the real expenditure of all hospital departments. Results – The direct in‐hospital cost for all stroke cases was 1,551,445€ for a total of 4674 days (331.9€ per day in‐hospital). The mean in‐hospital cost per stroke patient was 3624.9€ (±2695.4). Hemorrhagic strokes were significantly more expensive than the ischemic strokes [mean 5305.4 (±4204.8)€ and 3214.5 (±1976.2)€, respectively) and lacunar strokes the least expensive among ischemic stroke subtypes. The length of stay was highly correlated with in‐hospital total cost. Multivariate linear regression analysis showed that admission ward, stroke severity on admission, stroke type and status discharge were independent predictors of cost. Conclusions – Purchasers in our health services should differentiate in their cost estimates and pricing schemes between types of cerebrovascular events. Future studies should focus on modifiable factors related, not only with stroke characteristics, but also with operational policies of hospitals, that may influence length of stay.     

Acute treatment costs of intracerebral hemorrhage and ischemic stroke in Argentina

Background and purpose – Stroke is the third leading cause of death in Argentina, yet little information exists on the acute treatment provided for stroke or its costs. This study estimates the national costs of the acute treatment of first‐ever intracerebral hemorrhage (ICH) and ischemic stroke (IS) in Argentina. Methods – Retrospective hospital‐based inception study design using data on resource use and costs from high‐volume stroke centers in Argentina, and published population‐based incidence data. Treatment provided at two large urban hospitals were evaluated in all patients admitted with a first‐ever stroke between 1 January 2004 and 31 August 2006, and costs were assigned using appropriate unit cost data for all resource use. Cost estimates in Argentinian pesos were converted to US dollars ($) using the 2005 purchasing power parity index. National costs of acute treatment for incident strokes were estimated by extrapolation of average costs estimates to national incidence data. Assumptions of the average cost of stroke treatment on a national scale were examined in sensitivity analysis. Results – The acute care of 167 patients with stroke was thoroughly evaluated from hospital admission to hospital discharge. Mean length of hospital stay was 35.4 days for ICH and 13.0 days for IS. Ninety‐one percent of the patients with ICH and 68% of the patients with IS were admitted to an ICU for a mean length of stay (LOS) of 12.9 ± 20.3 and 3.6 ± 5.9 days respectively. Mean total costs of initial hospitalization were $12,285 (SD ±14,336) for ICH and $3888 (SD ±4018) for IS. Costs differed significantly by Glasgow Coma Scale (GCS) score at admission, development of pneumonia and infections during hospitalization, and functional outcome at hospital discharge. Aggregate national healthcare expenditures for acute treatment of incident ICH were $194.2m (range 97.1–388.4) and $239.9m for IS (range 119.9–479.7). Conclusion – The direct hospital costs of incident ICH and IS in Argentina are substantial and primarily driven by stroke severity, in‐hospital complications and clinical outcomes. With the expected increase in the incidence of stroke over the coming decades, these results emphasize the need for effective preventive and acute medical care.     

Costs of stroke care according to handicap levels and stroke subtypes

BACKGROUND: If new advances in stroke management are to be put into practice, crucial information about their costs needs to be considered in relation to clinically pertinent variables (e.g. handicap level and stroke subtypes). Details of costs throughout the entire period of stroke care are essential in the political decision-making process, in order to avoid other budget-balancing approaches, which are not always satisfactory. Our aim was to perform an in-depth evaluation of the direct medical cost of stroke care in a large cohort. METHODS: We included 435 consecutive patients with brain infarction in 12 primary-care and referral neurology departments. Information on acute care was prospectively collected. Information on postacute care was collected by research nurses' visits to the patient's or a relative's home 18-40 months after the stroke onset. We thus collected detailed information on handicap levels, stroke subtypes, acute hospitalization costs, rehabilitation, nursing care and ambulatory costs. This enabled us to calculate costs over an 18-month period after the initial acute hospital discharge. RESULTS: By the 12th month after discharge, the costs amounted to 17,799 euros (16,440-19,158) per patient; the initial hospitalization accounted for 42% of this cost, rehabilitation for 29% and ambulatory care for 8%. These costs were mostly concentrated within the first 3- to 6-month period. After 46 months without recurrence, the cost of ambulatory care outweighed the cost of the first 6 months. Handicap levels explained 43% of the variance of costs (p < 0.0001) and, according to the Rankin scale divided into 3 classes (0-2, 3 and 4-5), cumulative costs over time differed considerably. Stroke subtypes were not discriminating variables except for lacunar strokes, which were significantly less costly than the other groups. CONCLUSIONS: By providing a fairly comprehensive figure for the details of direct costs of stroke care over time, our study gives some clues about the economic burden of stroke care which is mostly driven by a high handicap level. This suggests that any early intervention aimed at reducing the handicap level will probably dramatically reduce this burden.     

Status and costs of primary prevention for ischemic stroke in China

Despite the benefits in reducing the risk of stroke, primary prevention is not well translated into practice. We sought to evaluate patient compliance with guidelines and the cost of primary stroke prevention in southwest China. We consecutively enrolled 305 patients with headaches and/or dizziness who were at high risk of stroke from our hospital. We retrospectively obtained their information, including the extent of their knowledge of stroke risk factors, adherence to guidelines, medications taken, and costs of primary prevention for stroke within the past year. Only 45.9% of patients had any knowledge of primary prevention, and only 17.0% had completely followed guidelines. Moreover, 79.0% of the patients were using medications, but only 39.3% took their medication as recommended. In patients who took medication, 89.6% were prescribed by physicians. The annual costs of primary prevention were estimated to be US$517.8 per capita, which included direct medical costs (US$435.4), direct non-medical costs (US$18.1), and indirect costs (US$64.3). Costs in the hypertension group were less than those reported by a similar international study. Although our population sample may not be representative of the population at high risk of stroke in China, it is appropriate for the evaluation of our primary prevention system. Primary prevention for stroke in southwest China is very challenging, with few medical resource investments. There is a current urgency to improve patient knowledge of primary prevention, which would bridge the gaps between guidelines and practice and increase medical resource investments.     

Management patterns and health care use after intracerebral hemorrhage. a cost-of-illness study from a societal perspective in Germany

BACKGROUND: The German cost-of-illness study of stroke is a multicenter study in 6 departments of internal medicine, 9 departments of general neurology and 15 departments of neurology with an acute stroke unit. The aims of this study are to describe the management patterns, cost of treatment and overall resource utilization after intracerebral hemorrhage (ICH) as well as the major differences to ischemic stroke (IS). METHODS: During a 12-month period, 30 participating centers with a special interest in stroke prospectively included 586 patients with ICH which were collected in a joint data bank. About 75% of all patients could be centrally followed up via structured telephone interviews after 3 and 12 months to assess further acute hospital and rehabilitation stays, outpatient resource utilization, functional outcome and quality of life. RESULTS: Mortality after 3 months (33.5%) was markedly higher than in patients with IS from the same hospitals. Accordingly, only 30.9% of patients had regained independent functional status after 3 months. Cumulative cost of treatment amounted to 5301 EUR for inpatient stay in the documenting hospital and 8920 EUR for the overall hospital stay including rehabilitation. Mean direct cost after discharge during the first year amounted to 4598 EUR and the loss of work force was equivalent to 5537 EUR in all surviving patients. CONCLUSION: This study provides a comprehensive overview of patient characteristics, treatment strategies and health care cost of ICH from a societal perspective in Germany.     

Langzeitkrankheitskosten 4 Jahre nach Schlaganfall oder TIA in Deutschland

BACKGROUND: The economic burden of stroke is considerable. While studies on the costs of acute stroke treatment have been undertaken in Germany, thorough analysis of direct and indirect long-term costs is lacking. PATIENTS AND METHODS: A hospital-based cohort of 151 consecutive patients with stroke or transient ischemic attacks (TIA) was followed up (medical examination and interview) at the end of the 4th year following the cerebrovascular event. Costs were calculated using a bottom-up approach and classified into direct medical and nonmedical costs, indirect costs, and patients' costs. RESULTS: Non-stroke-related costs (mean +/- standard deviation 4,610+/-9,310 Euros/person) were separated from total costs. Total stroke-related costs of the 4th year after stroke/TIA amounted to 7,670+/-10,250 Euros per person. The cost components were as follows: direct costs 56% (4,320+/-5,740 Euros), indirect costs 31% (2,350+/-2,710 Euros), and patients' payments 13% (1,000+/-4,100 Euros). The annual nationwide costs for the 4th year following stroke or TIA amounted to approximately 3 billion Euros. CONCLUSION: The considerable size of long-term costs after stroke/TIA is mainly due to direct costs and poses an economic challenge to the German health care system. Patients contribute in a relevant way by their own payments.     

Cost of acute ischemic and hemorrhagic stroke in Turkey

Objective

The aim of this study is to examine the direct medical costs and outcomes of patients with stroke.

Material and methods

The records of the patients admitted with ischemic and hemorrhagic stroke to the University of Trakya, School of Medicine, Department of Neurology were reviewed retrospectively in year 2007. Direct medical costs (total costs, radiological, laboratory, medicine, and other) were calculated, additionally cost per life saved and per life-year saved were calculated for stroke patients.

Results

The study group consisted of 328 patients (169 male/159 female) and mean age was 66.5 ± 12.4 years. Length of hospital stay was 10.7 ± 7.5 days. Mortality rate was 20.4% and the mRS score of the patients was 3.2 ± 2.1. The average cost of stroke was US$ 1677 ± 2964 (29.9% medicine, 19.9% laboratory, 12.8% neuroimaging, and 38% beds and staff). Cost per life saved and per life-year saved were US$ 2108 and US$ 1070, respectively.

Conclusion

This is the first study in order to determine direct medical cost of stroke in Turkey, therefore, it may be guideline for disease-cost management of stroke.     

Annual direct medical cost and contributing factors to total cost of epilepsy in Oman

OBJECTIVES: To describe the pharmaceutical use, health care resource utilisation patterns, and annual direct medical cost of epilepsy as well as determining the impact of various demographic and clinical characteristics on total costs of epilepsy in Oman. METHODS: Medical and pharmacy data were collected for 6 months on all patients aged > or =13 years attending the Sultan Qaboos University Hospital. Unit pharmacy and medical costs were retrieved for each patient, and multiple linear regression was utilised to analyse the impact of various demographic and clinical characteristics on total cost. RESULTS: A total of 486 patients were seen over the study period. Annual direct medical costs of epilepsy amounted to 1,426 US dollars. In-patient care, the antiepileptic drug (AED) lamotrigine and specialist visits, respectively, were the first, second and third most significant predictors of total cost. Age was associated positively, and was the most significant predictor of total costs among demographic and clinical parameters. CONCLUSIONS: This analysis, the first economic study of epilepsy in Oman, could assist in health care allocation of scarce resources and in pharmacoeconomic analysis of AEDs. Besides in-patient admission, our findings demonstrate that the newer drugs are significant predictors of total cost, and hence any incremental benefits derived from them must be rigorously assessed for their cost-effectiveness.     

Predictors for total medical costs for acute hemorrhagic stroke patients transferred to the rehabilitation ward at a regional hospital in Taiwan

Background:

One-third of the acute stroke patients in Taiwan receive rehabilitation. It is imperative for clinicians who care for acute stroke patients undergoing inpatient rehabilitation to identify which medical factors could be the predictors of the total medical costs.

Objectives: The aim of this study was to identify the most important predictors of the total medical costs for first-time hemorrhagic stroke patients transferred to inpatient rehabilitation using a retrospective design.

Methods: All data were retrospectively collected from July 2002 to June 2012 from a regional hospital in Taiwan. A stepwise multivariate linear regression analysis was used to identify the most important predictors for the total medical costs.

Results: The medical records of 237 patients (137 males and 100 females) were reviewed. The mean total medical cost per patient was United States dollar (USD) 5939.5?±?3578.5.The following were the significant predictors for the total medical costs: impaired consciousness [coefficient (B), 1075.7; 95% confidence interval (CI)?=?138.5–2012.9], dysphagia [coefficient (B), 1025.8; 95% CI?=?193.9–1857.8], number of surgeries [coefficient (B), 796.4; 95% CI?=?316.0–1276.7], pneumonia in the neurosurgery ward [coefficient (B), 2330.1; 95% CI?=?1339.5–3320.7], symptomatic urinary tract infection (UTI) in the rehabilitation ward [coefficient (B), 1138.7; 95% CI?=?221.6–2055.7], and rehabilitation ward stay [coefficient (B), 64.9; 95% CI?=?31.2–98.7] (R²?=?0.387).

Conclusions: Our findings could help clinicians to understand that cost reduction may be achieved by minimizing complications (pneumonia and UTI) in these patients.     

Predictors of acute hospital costs for treatment of ischemic stroke in an academic center

BACKGROUND AND PURPOSE: We sought to determine predictors of acute hospital costs in patients presenting with acute ischemic stroke to an academic center using a stroke management team to coordinate care. METHODS: Demographic and clinical data were prospectively collected on 191 patients consecutively admitted with acute ischemic stroke. Patients were classified by insurance status, premorbid modified Rankin scale, stroke location, stroke severity (National Institutes of Health Stroke Scale score), and presence of comorbidities. Detailed hospital charge data were converted to cost by application of department-specific cost-to-charge ratios. Physician's fees were not included. A stepwise multiple regression analysis was computed to determine the predictors of total hospital cost. RESULTS: Median length of stay was 6 days (range, 1 to 63 days), and mortality was 3%. Median hospital cost per discharge was $4408 (range, $1199 to $59 799). Fifty percent of costs were for room charges, 19% for stroke evaluation, 21% for medical management, and 7% for acute rehabilitation therapies. Sixteen percent were admitted to an intensive care unit. Length of stay accounted for 43% of the variance in total cost. Other independent predictors of cost included stroke severity, heparin treatment, atrial fibrillation, male sex, ischemic cardiac disease, and premorbid functional status. CONCLUSIONS: We conclude that the major predictors of acute hospital costs of stroke in this environment are length of stay, stroke severity, cardiac disease, male sex, and use of heparin. Room charges accounted for the majority of costs, and attempts to reduce the cost of stroke evaluation would be of marginal value. Efforts to reduce acute costs should be monitored for potential cost shifting or a negative impact on quality of care.     

The economic burden of stroke in Italy. The EcLIPSE Study: Economic Longitudinal Incidence-based Project for Stroke Evaluation

Abstract Stroke is the second most common cause of death in the world. The aim of this study is to estimate stroke’s direct costs and productivity losses in Italy from a societal perspective and to explain cost variability. A prospective observational multicentre cost of illness study was designed. Four hundred and forty-nine consecutive patients admitted because of acute first-ever stroke in 11 Italian hospitals were enrolled. Costs and outcomes were assessed at patients’ enrolment, and at 3, 6 and 12 months after discharge. Overall, social costs in the first six months following the attack were € 11 600 per patient; 53% of this was health care costs, 39% non-health care costs and the remaining 8% productivity losses. Age, level of disability and type of hospital ward were the most significant predictors of six-month social costs. The acute phase counted for more than 50% of total health care costs, leaving the remaining 50% to the post-acute phase, indicating that follow-up should be on the agenda of policy makers also.     

Annual Direct Cost of Dysphagia Associated with Acute Ischemic Stroke in the United States

BackgroundDysphagia after acute ischemic stroke is frequent and increases the risk of pneumonia, insertion of feeding tube, hospital length-of-stay and rates of discharge to institutional care. However, the financial impact of dysphagia after acute ischemic stroke is not well understood.MethodsEstimates were derived from published medical and economic literature to provide a range of estimates for the annual direct hospital cost of dysphagia associated with acute ischemic stroke in the United States. We also estimated the cost savings associated with a hypothetical new therapeutic intervention under a variety of assumptions.ResultsThe 1-year costs per patient of acute hospital and post hospitalization care were $67,100 to $112,400 in acute ischemic stroke patient with dysphagia and $54,0310 to $51,979.8 in acute ischemic stroke patient without dysphagia in the two models. The estimated incremental cost in United States for ischemic stroke patients with dysphagia was $ 4,610,038,961.13 (95% confidence interval [CI] $3,796,502,674-$5,423,575,248) according to assumptions of Model 1. The estimated incremental cost in United States for ischemic stroke patients with dysphagia was $ 20,114,218,586.23 (95% CI $16564650600.42-$23663786572.04) according to assumptions of Model 2. The cost savings per year with a new therapeutic intervention ranged from $509,444,886.6 to $3,601,651,036 depending upon the magnitude of benefit.ConclusionOur analysis provides additional justification using financial basis for a much larger investment in research and development for treatment of dysphagia associated with ischemic stroke.     

An analysis of the costs of ischemic stroke in an Italian stroke unit.

OBJECTIVE: To determine the direct costs of hospital care of acute ischemic stroke in a large Italian hospital, and to identify the main components of such costs. BACKGROUND: Cost containment in stroke care requires an up-to-date assessment of expenditures in the different areas of stroke management. However, costs may vary among countries because of different health system organizations. METHODS: All patients with ischemic stroke admitted during 1996 were considered. Total cost was the sum of a daily component, reflecting personnel wages and general care, and an ancillary component, reflecting mostly investigations and treatments. The real costs were used, not fixed charges. RESULTS: We included 245 patients, with a mean length of stay (LOS) of 13.1+/-7.0 days, and an in-hospital case fatality rate of 8.2%. The mean total cost per patient was 5,087,000+/-2,536,000 Italian Lira (LIT; $3,289+/-$1,640), with a mean cost per day of 388,000 LIT ($251). Approximately 80% of total costs were due to the daily component and 20% to the ancillary component. A multiple linear regression model of length of stay, which determines the daily cost, showed that the Rankin score at entry, the clinical syndrome type, and the destination at discharge independently contributed to LOS. A second linear regression model showed that younger age and longer LOS significantly increased ancillary costs. CONCLUSIONS: The containment of hospital costs of ischemic stroke may be achieved mostly through measures that reduce LOS, such as effective treatments and a quicker deployment.     

Utilization of health care resources after stroke. A population-based study of 258 hospitalized cases followed during the first year

ABSTRACT In a prospective population-based study the cumulative utilization of health care resources (and the rehabilitation outcome) was followed in consecutive stroke patients 3, 6 and 12 months after the onset of the disease. The study group comprised 258 patients diseased during the period February 1st 1986-January 31th 1987. The pattern of various forms of hospital beds and non-hospital facilities in open care utilized during the first post-stroke year was analysed at 1986 year's cost level. The mean utilization of acute hospital beds during the initial phase was 15 days; at an expenditure cost of 26,670 SEK (3,683). The mean utilization of acute hospital and of geriatric beds during the first year was 19 and 59 days respectively. Thus the total hospital bed days amounted to a mean of 78 days; at a mean expenditure of 87,000 SEK (12,000); 70% of the patients were discharged from hospital care to independent living after 36 days. The acute care hospital provided 36% and geriatric care 64% of the beds needed before discharge. The expenditure of non-hospital facilities was mean 19,000 SEK (2600); thus total expenditure for health care amounted to 106,000 SEK (14,600). The relation between non-hospital and hospital care was approximately 1 to 5. Severity of the stroke influenced markedly the pattern and the total utilization of both hospital and non-hospital care. Patients with major stroke utilized health care resources at an expenditure 3.5 times that used by patients with minor stroke. Age of the patient also influenced health care utilization. However, age had no influence on mean utilization of acute hospital beds but influenced the utilization of geriatric beds and non-hospital facilities. The large amount of acute hospital bed days used by the older patients depended entirely on their increased number. When only patients with major stroke were analysed, the impact of age on health care utilization became less prominent. The effort to prevent and/or minimize the disability following stroke stands out as the dominant and most desirable approach to save resources and human suffering.     

Potentially treatable causes of poor outcome in acute stroke patients with urinary incontinence

OBJECTIVE: To identify potentially treatable clinical risk factors responsible for poor outcome in acute stroke patients with urinary incontinence. MATERIAL AND METHODS: All acute stroke patients admitted to our hospital within a 12-month period were considered for inclusion in this observational prospective study. Their clinical details were recorded prospectively during the hospital stay and at 3 months. RESULTS: Two hundred and fifteen patients with complete records were enrolled in the study. After adjusting for age, disability, and comorbidity, urinary incontinence at admission was a significant predictor of stroke death at 3 months [hazard ratio 2.8 (95% CI 1.3 5.8), P = 0.006]. Stroke patients incontinent of urine were malnourished and had an increased risk of infective complications during the hospital stay compared with those without incontinence. CONCLUSION: Part of the poor outcome associated with incontinence of urine after acute stroke may be due to treatable conditions such malnutrition and infections.     

Home or hospital for stroke Rehabilitation? Results of a randomized controlled trial : II: cost minimization analysis at 6 months

BACKGROUND AND PURPOSE: The goal of the present study was to examine the resource and economic implications of an early hospital discharge and home-based rehabilitation scheme for patients with acute stroke. METHODS: A cost minimization analysis in conjunction with a randomized controlled trial was carried out at 2 affiliated teaching hospitals in the southern metropolitan region of Adelaide, South Australia, between 1997 and 1998. Eighty-six hospitalized patients with acute stroke who required rehabilitation were randomized to receive both early hospital discharge and home-based rehabilitation, or conventional in-hospital rehabilitation and community care. Direct and indirect costs related to stroke rehabilitation were calculated, including hospital bed days, home-based intervention program, community services, and personal expenses during the 6 months after randomization. RESULTS: The mean cost per patient was lower for patients randomized to the early hospital discharge and home-based rehabilitation ($8040) compared with those who received conventional care ($10 054). This cost saving was not statistically significant (P=0.14). However, sensitivity analyses indicated that the cost of home-based rehabilitation was consistently lower than that of conventional care except when hospital costs were assumed to be 50% less than those used in the main analysis. Multiple regression analysis demonstrated that the cost of the home-based program was significantly related to a patient's level of disability after adjustment for age, comorbidity, and the presence or absence of a caregiver. CONCLUSIONS: The early hospital discharge and home-based rehabilitation scheme was less costly than conventional hospital care for patients with stroke. Limitation of the provision of such services to patients with mild disability is likely to be most cost effective.     

Difference of hospital charges for stroke inpatients between hospitals with different levels and therapeutic modes in Beijing,China

Objectives: The present study analyzed the hospital charges for stroke patients in China and determined the factors associated with hospital costs. Methods: Medical records of hospitalized patients with a primary diagnosis of acute stroke were collected from 121 hospitals in Beijing (2012). Distribution characteristics of hospital charges for different stroke types, hospital levels and types were studied. Factors influencing total hospital charges were analyzed. Results: 60.8% of the 94?906 stroke patients were male and the mean age of these patients was 66.5 ± 13.2 years. The median length of hospital stay (LOHS) for these patients was 14 d (interquartile range, IQR 9–19). The mean hospital charge per patient was 19?270 Chinese Yuan. Forty-five percent of these charges were for medicine, 18% for laboratory and examination, 16% for material, 15% for therapy, 5% for service and 1% for blood product. The mean hospital charge for patients suffering from hemorrhagic stroke was significantly more than ischemic stroke (34?937 vs. 17?049, p < 0.001), and was significantly more for Level 3 than Level 2 hospitals (23?762 vs. 14?554, p < 0.001). LOHS, hospital level and stroke severity were key determinants of the hospital charge. Conclusions: Though hospital charges for stroke patients in China were low, it brought a heavy economic burden for the larger stroke population. Medicine accounted for the largest percentage of hospital charges in China. LOHS emerged to be the main predictor of the cost. Decreasing medicine charge and LOHS might be strategies to decrease hospital charges and reduce economic burden of stroke in China.     

Real-life costs and effects of an implementation program to increase thrombolysis in stroke

OBJECTIVES: We have shown that a Breakthrough Series-based implementation program increases the number of patients with acute ischemic stroke treated with alteplase 4.5% in real-life settings. It is unclear whether such an implementation program is cost-effective. METHODS: The practice study includes 12 randomized hospitals and 5,515 patients. Its present cost-effectiveness analysis involves 1,657 patients with ischemic stroke admitted within 4 hours from onset. Defined primary outcomes are thrombolysis rate and actual health care costs up to 3 months, including additional implementation efforts. Secondary outcomes are lifetime quality-adjusted years (QALYs) and lifetime costs of individual trial patients, using a validated probabilistic, disability-stratified stroke life table. Differences in outcome include 95% confidence intervals (CI), adjusted for intracluster correlation. RESULTS: The thrombolysis rate in the intervention group was 44.3% vs 39.8% in the control group (difference 4.5%; 95% CI 3.1% to 5.9%. Mean costs per patient at 3 months (euros were converted to 2010 USD) were $9,192 USD in the intervention group and $9,647 USD in the control group (difference -$455 USD; 95% CI -$232 to -$679 USD). Lifetime QALYs in the intervention group were 3.89 and in the control group 3.84 (difference 0.05; 95% CI -0.04 to 0.14). The mean lifetime costs in the intervention group were $22,994 USD against $24,315 USD in the control group (difference -$1,321 USD; 95% CI -$1,722 to -$921 USD). CONCLUSIONS: A Breakthrough Series implementation program of thrombolysis increases thrombolysis. It saves short- and long-term health care costs due to lower hospital admission and residential costs, increasing stroke care efficiency.     

Evaluation of costs and outcome in cardioembolic stroke or TIA

The costs of acute stroke care, length of hospital stay (LOS), and outcome in patients with cardioembolic stroke or cardioembolic transient ischemic attacks (TIA) were investigated with the aim of estimating the clinical and health-economic impacts of cerebral cardioembolism. The study population consisted of 511 consecutive patients with the diagnosis of ischemic stroke (n = 379) or TIA (n = 132) treated at the Department of Neurology, Philipps University, Marburg. Cerebral cardioembolism was defined according to the criteria of the Cerebral Embolism Task Force. Clinical status was assessed by means of Barthel index (BI) and modified Rankin Scale. Costs were calculated using a bottom-up approach. All costs (in Euros) were inflated to the 2008 level. Compared to non-cardioembolic stroke (n = 278) patients, patients who had suffered cardioembolic stroke (n = 101) had more severe clinical deficits on admission (BI 46.3 ± 27.0 vs. 59.3 ± 34.1; P < 0.01), worse recovery (BI on discharge 59.2 ± 28.9 vs. 73.1 ± 33.4; P < 0.01), and increased LOS (12.6 ± 5.7 vs. 10.0 ± 7.8 days; P < 0.01). The latter also required a relatively higher daily resource utilization due to increased expenses for personnel and diagnostics. Mean costs of acute care for patients with cardioembolic stroke [€ 4890 per patient (95% confidence interval 4460–5200)] were significantly higher than those for patients with non-cardioembolic stroke [€ 3550 (95% confidence interval 3250–3850); P < 0.01]. The clinical and health-economic impact of cardiogenic cerebral embolism on stroke care is considerable. Patients with cardioembolic stroke/TIA are more severely impaired, and they require longer hospital treatment and increased resource utilization. Costs of acute care of cardioembolic stroke/TIA patients may exceed those of non-cardioembolic stroke/TIA by up to 40%.     

Cost burden of neuroimaging during one-time admission for first-ever acute stroke in Nigeria

Objectives:To determine the cost burden of Neuroimaging and its contribution to direct total hospitalization costs (HCs) during one-time admission for first-ever stroke.Methods:The clinical characteristics, direct itemised costs and total HCs for 170 consecutive patients with first-ever stroke, admitted at our public tertiary health facility over a 15-month period were evaluated.Results:The records of 170 stroke subjects were reviewed. The median total HCs for one-time admission per stroke patient was $183.30 with a median daily cost of $15.86. Median cost of radiological investigations was the highest among the categorized hospital costs. Among the radiological investigations, neuroimaging accounted for at least 99% of cost to patients.Conclusion:The financial burden of radiological investigations, particularly neuroimaging, is high during one-time admission of patients with first-ever stroke in our environment.

The medical and economic burden of Stroke is immense.1 It is the leading cause of long term disability and the second leading cause of death globally.2 Economically, it imposes heavy financial burden on individuals and the society.2,3 In Nigeria, the prevalence of stroke is 14 per 1000 people and it has a case fatality rate of 40%. World Health Organization projects that approximately 80% of all stroke cases will occur in people living in low and middle income countries, including Nigeria.4 In the United States, there is increased interest in the economic aspects of stroke as a result of the prevailing emphasis on cost containment and managed healthcare/health insurance.5 In Nigeria, the National Health Insurance Scheme (NHIS) became fully operational in 2005.6,7 Out of a population of about 190 million, only 3% are registered in the NHIS.8 Therefore, over 90% of health financing is by private out-of-pocket expenditure.9 About 57% of the Nigerian population falls below the poverty line which is defined as an average income of $1 per day.10 The minimum monthly wage in Nigeria is 18,000 naira (57 US dollars).11 With such indices, it is imperative to establish the cost burden of diseases, especially those with long term disabilities like stroke, for more effective healthcare planning, implementation and resources allocation for a healthier nation. Few studies have evaluated the cost of in-hospital stroke care in different populations with regional differences in total and itemized hospitalization costs.12,13-27 As there could be regional and institutional variations in the in-hospital algorithms for stroke care percentage contribution of itemized hospitalization costs to the total hospitalization cost have varied among these studies. Neuroimaging is required for all stroke patients presenting in our hospital. This is similar to what obtains elsewhere.13 Undergoing neuroimaging immediately after stroke has also been shown to be associated with better outcome and a higher number of quality adjusted life years.28 There is no data on the cost burden of in-hospital care of managing stroke in Nigeria. Available data on cost burden of stroke is on the post-stroke period which showed that the minimum cost needed in a government hospital is ₦95,100 ($600 as of 2012) and the minimum cost needed in a private hospital is ₦767,900 ($4860 as of 2012), within the first 36 months of post stroke affectation.2 A local study to determine the direct cost of in-hospital stroke care and how different hospital services contribute to the total direct cost in our environment where health insurance coverage is limited is needed. This will provide data for government policy makers to develop a health system that will minimize the financial burden of in-hospital care of stroke on individuals and the society. This study was done to evaluate the contributions of itemized hospitalization costs, particularly neuroimaging expenses, to total hospitalization cost during one-time admission for first-ever stroke in a tertiary hospital in order to guide policy decisions.29