Cost of Stroke Care Does Not Decrease Over Long Term

October 23, 2014

The first study to examine the cost of stroke out to 10 years after the acute event has shown that costs do not diminish in the long term as has previously been suggested.

The study, published online October 23 in Stroke, looked at costs associated with 243 patients with ischemic stroke and 43 patients with intracerebral hemorrhage who had survived for 10 years or more. The patients had participated in an earlier regional study that estimated 5-year costs. The study was conducted in Australia but costs were reported in US dollars.

Results showed that annual direct costs of care for a patient with ischemic stroke were $5207 at 10 years, which was similar to the costs between 3 and 5 years ($5438).

However, for hemorrhagic stroke, annual costs increased significantly in the long term and were considerably higher at 10 years ($7607) than at 3 to 5 years ($5807).

For ischemic stroke, the most important direct cost categories at 10 years were aged care facilities, informal care, and medications. While medication costs were slightly greater at 10 years than at 3 to 5 years, costs of inpatient rehabilitation were lower at 10 years than at 3 to 5 years.

For hemorrhagic stroke, costs of aged care facilities were 64% greater at 10 years than at 3 to 5 years, and medication costs were 1.7-fold greater.

On the basis of these new data and life expectancy models, the researchers estimated lifetime costs as $68,769 for a patient with ischemic stroke and $54,956 for a patient with hemorrhagic stroke, both considerably higher than previous estimates.

Senior author, Dominique Cadilhac, PhD, Stroke and Ageing Research Centre, Monash University, Victoria, Australia, said the high lifetime costs for patients with stroke emphasize the significant economic implications of stroke.

"No one has done a cost study before in which a well-characterized population of stroke patients has been followed for 10 years," she commented to Medscape Medical News. "We have very good information on what type of stroke these patients had and the care they are receiving."

She also noted that most previous cost studies have ignored costs to patients, their caregivers, and broader effects on work force participation and household productivity. "Our data provide important current practice estimates for economic evaluations of the potential impact of new or existing interventions. Therefore, these data can serve a variety of purposes for health planning and policy decision-making," she said.

Dr Cadilhac stressed that the results of this study re-emphasized the importance of prevention. "Stroke is a preventable condition, and we need to be doing everything possible to prevent it in terms of managing modifiable risk factors such as blood pressure and diabetes," she said. "Greater implementation of primary prevention interventions, such as reducing salt in manufactured foods to assist in lowering blood pressure, is needed."

She also pointed out that ensuring patients get best practice acute care at the time of the stroke will prevent long-term disability and reduce long-term costs.

"Unfortunately, not all patients get the best care as access delivered in acute stroke units because of capacity issues. If we invest in acute stroke units this will pay off in the long term — there is some data on this."

Dr Cadilhac (cofunded by National Heart Foundation) and a coauthor were supported by fellowships from the National Health and Medical Research Council (NHMRC; Australia). Other authors were supported by a scholarship from the Koeln Fortune Program, Faculty of Medicine, University of Cologne, Germany, and a PROMOS grant (1000 euros) from the German Academic Exchange Service, used to support work on this project in Australia. The North East Melbourne Stroke Incidence Study (NEMESIS) was funded with grants from the NHMRC, VicHealth, the Foundation for High Blood Pressure Research, and the National Stroke Foundation. The authors have disclosed no relevant financial relationships.

Stroke. Published online October 23, 2014. Abstract

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