The economic costs of stroke in Massachusetts

Rapid systematic review of readmissions costs after stroke

BACKGROUND

Stroke readmissions are considered a marker of health quality and may pose a burden to healthcare systems. However, information on the costs of post-stroke readmissions has not been systematically reviewed.

OBJECTIVES

To systematically review information about the costs of hospital readmissions of patients whose primary diagnosis in the index admission was a stroke.

METHODS

A rapid systematic review was performed on studies reporting post-stroke readmission costs in EMBASE, MEDLINE, and Web of Science up to June 2021. Relevant data were extracted and presented by readmission and stroke type. The original study's currency values were converted to 2021 US dollars based on the purchasing power parity for gross domestic product. The reporting quality of each of the included studies was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

RESULTS

Forty-four studies were identified. Considerable variability in readmission costs was observed among countries, readmissions, stroke types, and durations of the follow-up period. The UK and the USA were the countries reporting the highest readmission costs. In the first year of follow-up, stroke readmission costs accounted for 2.1-23.4%, of direct costs and 3.3-21% of total costs. Among the included studies, only one identified predictors of readmission costs.

CONCLUSION

Our review showed great variability in readmission costs, mainly due to differences in study design, countries and health services, follow-up duration, and reported readmission data. The results of this study can be used to inform policymakers and healthcare providers about the burden of stroke readmissions. Future studies should not solely focus on improving data standardization but should also prioritize the identification of stroke readmission cost predictors.

International Comparison of Stroke Cost Studies

PURPOSE

With the rapid international spread of interventions, there is a need to understand the economic implications of these changes and to interpret these economic implications on the international level. The purpose of this study is to systematically compare total health care expenditures on stroke, the costs of stroke per capita, and the distribution of stroke costs within different countries, with special attention to the allocation of resources among different health care facilities.

METHODS

Studies for this literature review were selected by conducting a literature search from January 1966 to July 2003. Key methodological, country-related, and monetary issues of the selected stroke cost studies were evaluated using a checklist.

RESULTS

After selection, 25 stroke cost studies were reviewed. Although the selected cost of illness studies used different methodologies, the estimated expenditures for stroke are approximately similar. The proportion of national health care in the 8 countries studied is unequivocal for the more recent studies, ie, approximately 3% of total health care expenditures. A shift is observed from the inpatient treatment costs (in the first year) toward outpatient treatment and long-term care costs (in the latter years). Furthermore, it is remarkable that in the studies, little attention is paid to costs borne by the patient and family or to the costs of comorbidity.

CONCLUSIONS

This study highlights the importance of studying the economic consequences of stroke and of interpreting the results on the international level. The results of stroke cost studies provide insight into the distribution of the costs of stroke and the impact of stroke on the national expenditure on health care.

Analysis of hospital charges for ischemic stroke in Fukuoka, Japan

OBJECTIVES

Stroke is a heavy economic burden on individuals, society, and health services in Japan, where health expenditures are rising rapidly. The objective of the present study was to examine medical services and demographic factors associated with increased inpatient charges for ischemic stroke in Japan.

SUBJECTS AND METHODS

The study subjects were 316 patients with a principal diagnosis of acute ischemic stroke who were discharged from the National Kyushu Medical Center Hospital from 1 July 1995 through 31 June 1999. Demographic, clinical, and administrative data were retrospectively collected from medical records and the hospital Clinical Financial Information System (CFIS). The influence of social and medical factors on total charges was analyzed using the stepwise multiple regression model.

RESULTS

Among the total subjects, the mean (median) length of hospital stay (LOHS) was 33 (30) days (range, 2-155 days). The mean (median) hospital charge per patient was US dollars 9020 (dollars 7974) with a range of dollars 336-54,509. The distribution of charges was 42% for fundamental, 17% for injection therapies, 13% for radiological test, 11% for other laboratory examinations, 3% for drugs, and 3% for operations. Stepwise multiple regression analysis revealed that LOHS was the key determinant of the hospital charge (partial R2=0.5993, P=0.0001). Operations (P=0.0001) and angiography (P=0.03) were also independent but less contributory determinants of the hospital charge.

CONCLUSIONS

LOHS was strongly, positively associated with inpatient charges for ischemic stroke in Japan. This implies that significant charge reductions are more likely to rely on shortening LOHS, which probably can be achieved by altering reimbursement policies.

Analysis of hospital charges for cerebral infarction stroke inpatients in Beijing, People's Republic of China

OBJECTIVE

Stroke is a heavy economic burden on the individuals, society and health services in China, where health expenditure is rising rapidly. The purpose of the present study is to examine health services and demographic factors associated with inpatient charges for cerebral infarction in China, focusing on hospital charges of insured and uninsured patients.

METHODS

The study subjects were 545 patients with a principal diagnosis of cerebral infarction stroke who were discharged from the China-Japan Friendship Hospital from January 1, 1997 through December 31, 1998. Demographic, clinical and administrative data were retrospectively collected from the medical record and financial database. The influence of social and medical factors on total charges was analyzed with stepwise multiple regression model.

RESULTS

Of 545 subjects, 429 (79%) were the insured patients and 116 (21%) were the uninsured patients. Length of hospital stay (LOHS) for the insured patients (median, 32 days) was significantly longer (P<0.001) than that for the uninsured (median, 23 days). The hospital charges per discharge for the insured was significantly higher (geometric mean, 10407 yuan) (P<0.0001) than that for the uninsured patients (geometric mean, 5857 yuan). With stepwise multiple regression, factors associated independently with the hospital charge were: longer hospital stay, insurance status, increased number of head magnetic resonance imaging (MRI) and computerized tomography (CT), infection in hospital stay, and more severe condition of stroke.

CONCLUSIONS

Inpatient charge for cerebral infarction stroke was positively associated with being the insured. The findings suggest an overuse of health care resources in insured patients and limited use of resources by those who are not.

Cost of stroke in Australia from a societal perspective: results from the North East Melbourne Stroke Incidence Study (NEMESIS)

BACKGROUND AND PURPOSE

Accurate information about resource use and costs of stroke is necessary for informed health service planning. The purpose of this study was to determine the patterns of resource use among stroke patients and to estimate the total costs (direct service use and indirect production losses) of stroke (excluding SAH) in Australia for 1997.

METHODS

An incidence-based cost-of-illness model was developed, incorporating data obtained from the North East Melbourne Stroke Incidence Study (NEMESIS). The costs of stroke during the first year after stroke and the present value of total lifetime costs of stroke were estimated.

RESULTS

The total first-year costs of all first-ever-in-a lifetime strokes (SAH excluded) that occurred in Australia during 1997 were estimated to be A$555 million (US$420 million), and the present value of lifetime costs was estimated to be A$1.3 billion (US$985 million). The average cost per case during the first 12 months and over a lifetime was A$18 956 (US$14 361) and A$44 428 (US$33 658), respectively. The most important categories of cost during the first year were acute hospitalization (A$154 million), inpatient rehabilitation (A$150 million), and nursing home care (A$63 million). The present value of lifetime indirect costs was estimated to be A$34 million.

CONCLUSIONS

Similar to other studies, hospital and nursing home costs contributed most to the total cost of stroke (excluding SAH) in Australia. Inpatient rehabilitation accounts for approximately 27% of total first-year costs. Given the magnitude of these costs, investigation of the cost-effectiveness of rehabilitation services should become a priority in this community.

Costs of coronary heart disease and stroke: the case of Sweden

OBJECTIVES

To estimate the annual costs in Sweden of coronary heart disease (CHD) and stroke, and the potential cost savings if these clinical 'events' are avoided. The analysis is undertaken from a societal perspective, including both direct and indirect costs. Costs are calculated for five clinical conditions: (i) acute myocardial infarction (AMI), (ii) angina pectoris (AP), (iii) unstable angina (UA), (iv) congestive heart failure (CHF), and (v) stroke.

DESIGN

A retrospective study including patients admitted to the Department of Medicine at Södertälje Hospital during the period January 1993 to March 1995 with CHD or a stroke. Each patient was followed for 1 year after admission to the hospital. To estimate potential cost savings, the patient was used as his or her own control. The potential savings in direct costs if CHD or a stroke is avoided were estimated as the difference between costs for 1 year after and 1 year before the event. The indirect costs were calculated as the difference between the values of market production of goods and services the year before the event and the year after.

SETTING

The Department of Medicine at Södertälje Hospital, Södertälje, Sweden.

SUBJECTS

The patients included in the study were patients at the Department of Medicine at Södertälje Hospital in Sweden. The inclusion criterion was that the patients should have been admitted for the first time for CHD or stroke during the year 1994. To obtain 25 patients for each clinical category we first had to expand the inclusion period to cover January 1993 to March 1995. Secondly, we also had to include 36 patients with an earlier established uncomplicated CHD or stroke. Despite this, no more than 22 patients with UA were found.

INTERVENTIONS

Patients were followed in medical practice.

MAIN OUTCOME MEASURES

Costs, direct and indirect costs, and potential savings.

RESULTS

The mean direct costs during the year after a clinical event range between Swedish kronor (SEK) 41 000 for CHF and SEK 96 000 for stroke, whereas the mean potential savings in direct costs range from SEK 36 000 for CHF to SEK 91 000 for UA. The potential mean savings in indirect costs range between SEK 24 000 for CHF and SEK 102 000 for AMI. The direct costs for first-time patients are lower than those for patients with an earlier established CHD or stroke. No systematic differences have been found in potential direct cost savings and indirect costs between the two patient groups.

CONCLUSIONS

CHD and stroke are associated with high costs during the year after admission to the Department of Medicine. There are also large potential cost savings from the prevention of CHD and stroke. However, further studies, including more patients and costs arising in the municipality, are needed to establish more precise and complete estimates of the costs related to CHD and stroke.

Incorporating future costs in medical cost-effectiveness analysis: implications for the cost-effectiveness of the treatment of hypertension

It has been shown that the difference between consumption and production during life years gained should be included as a cost in cost-effectiveness analysis. In this study the authors estimate the impact of including these future costs on the cost-effectiveness of the treatment of hypertension in Sweden. The cost per quality-adjusted life year (QALY) gained changes little among young men and women due to the addition of future costs, but increases by about $14,000 for middle-aged men and women and about $27,000 for older men and women. When future costs are not included, the cost per QALY gained is generally lowest among older men and women, but when future costs are included, the cost per QALY gained is generally lowest among middle-aged men and women. The authors conclude that the total resource consequences of changes in mortality should be routinely considered in cost-effectiveness analyses.

Costs of medical care after first-ever stroke in The Netherlands

BACKGROUND AND PURPOSE

Stroke causes high morbidity and mortality. The aging of the population further increases the demands on healthcare costs.

METHODS

We estimated the lifetime direct costs of care of first-ever stroke patients in the Netherlands in 1991 using epidemiological data from national and international studies. In addition, we examined the effect of an aging population on future healthcare costs.

RESULTS

The lifetime costs for 24,007 first-ever stroke patients are estimated to be 1870 million Dutch guilders (Dfl) (1 Dfl = 0.53 US dollar, 1991). Per-person costs are higher for women (83,000 Dfl) than for men (71,000 Dfl). The major cost component of first-year costs is hospital costs (45%), while nursing home costs dominate lifetime costs (50%). An increase of the elderly population older than 65 years of 27% between 1991 and 2010 might lead to a parallel increase of total costs of 30%, or 1.5% per year.

CONCLUSIONS

Long-term care rather than acute care dominates the lifetime costs for stroke patients now and in the future.

The impact of age on the cost-effectiveness of hypertension treatment: an analysis of randomized drug trials

The aim of this study was to investigate whether any consistent pattern exists with respect to the cost-effectiveness of hypertension treatment and age, based on the results of randomized drug trials. Data about age, entry diastolic blood pressure, and relative risks of coronary heart disease (CHD) and stroke from 19 randomized trials were used to derive point estimates of the cost-effectiveness of each trial. The relationship between age and cost per life-year gained was then estimated by regression analysis, controlling for entry diastolic blood pressure. The regression analysis shows a statistically significant average decrease in the cost per life-year gained of about SEK 15,000 per year of older age for both men and women ($1 = SEK 6). Sensitivity analysis showed that the improvement in cost-effectiveness with age was stable towards various assumptions, but that the magnitude of the improvement varied greatly with the discount rate. Based on the results of randomized drug trials, it is concluded that the cost-effectiveness of hypertension treatment improves with patient age for both men and women.

The cost-effectiveness of the switch towards more expensive antihypertensive drugs

A switch from treatment with diuretics and beta-blockers to treatment with the more expensive ACE-inhibitors and calcium-antagonists has been noted in the hypertension field. The aim of this paper was to analyse the cost-effectiveness of this switch towards more expensive antihypertensive drugs in Sweden. The upper limit of the cost-effectiveness of ACE-inhibitors and calcium-antagonists compared with diuretics and beta-blockers was estimated by assuming that ACE-inhibitors and calcium-antagonists achieve the epidemiologically expected risk reduction for coronary heart disease. The incremental cost per life-year gained varies between approximately SEK 50,000 and approximately SEK 6,000,000 ($1 = SEK 6) in the different patient groups analysed. It is concluded that ACE-inhibitors and calcium-antagonists may be potentially cost-effective in some patient groups at a high risk of coronary heart disease. Since an improved risk reduction has not been demonstrated in clinical trials, however, ACE-inhibitors and calcium-antagonists cannot at present be recommended for hypertension treatment in any patient groups unless treatment with diuretics and beta-blockers is contraindicated.

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

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 87,0000 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.(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-effectiveness analysis of hypertension treatment--a review of methodological issues

There is a lack of methodological conformity in cost-effectiveness analyses of hypertension treatment. They differ with respect to assumptions about the effectiveness of treatment, the outcome measure chosen, the cost-concept, the discounting of effects and the duration of therapy. The aim of this paper is to review these issues and estimate the importance of different assumptions for the cost per life-year gained. To analyse these assumptions a computer simulation model was constructed based on the Framingham logistic risk equations and Swedish cost data. It is shown that the cost per life-year gained is highly sensitive towards many of these assumptions. It is also shown that the average cost-effectiveness ratios calculated in previous studies and the relevant marginal cost-effectiveness ratios can differ by several hundred per cent. The results of cost-effectiveness analyses in the hypertension field have to be interpreted with caution. Due to the lack of standardized methodology, the comparability between studies is limited. There is also a need to complement cost-effectiveness analysis in this area with other approaches, for example based on WTP.

Assessment and treatment of cognitive deficits in brain-damaged individuals

Rehabilitation professionals are recognizing the need for greater emphasis on treating cognitive as well as physical deficits in brain-damaged individuals. This review discusses recent advances in the development of treatments for patients with cognitive deficits secondary to brain damage. The review will focus upon treatments developed for problems with attention and vigilance, memory, language and reading abilities, visuoperceptual functioning, and driving skills. An overview of the treatment process presents the role of assessment and case conceptualization, patient and family education, application of rehabilitation interventions, and approaches to promoting recovery generalization and maintenance of relearned abilities.

The cost of head trauma in Olmsted County, Minnesota, 1970-74

A study of the total cost of head injury in Olmsted County, Minnesota, with the costs projected to the United States population, revealed that the annual cost for head trauma in the US can be estimated at approximately +12.5 billion using a 6 per cent discount rate. The nonmedical costs accounted for more than 92 per cent (+11.5 billion) of the total cost, while direct medical costs amounted to +1.0 billion.

Health in the workplace

General good health and the prevention of specific "non-occupational" disease, in addition to protection against occupational disease and injury, are already part of the aim and function of occupational health services. They are justified, if at all, mostly on the grounds of intangible benefits the virtue of which is not questioned. Concern over health costs and financial constraints are forcing industry to justify health expenditure. Yet, the health programmes can be justified, and industry has some obligation to adopt them.

Prevalence of stroke and its sequelae

A population-based stroke incidence study was carried out in a defined urban area of Melbourne in 1978-1979. From the incidence data, and survival curves to two years, estimates have been made of the prevalence of stroke, the prevalence of stroke survivors in different places of care, and the prevalence of stroke-related disability in an Australian community.

The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease, and stroke: a comparative analysis

The economic impact of disease and injury has most often been calculated by examining the costs associated with the prevalence of the impairments in the reference year. An alternative accounting approach is to assign all disease costs to the year of incidence, an approach which entails present-valuing to the year of incidence both health care expenditures and lost productivity. The incidence approach is the more appropriate for gauging the economic gains achievable through prevention, immediate rehabilitation, and arresting progression. Incidence-based costs have been estimated for the United States in 1975 for cancer, coronary heart disease, motor vehicle injuries, and stroke. A noteworthy finding is the relative economic importance of motor vehicle injuries, which frequently have been overlooked in the ordering of public health expenditure priorities. After cancer, which generated approximately $23.1 billion in present-valued costs in 1975 (discounted at 6 per cent), motor vehicle injuries and coronary heart disease constitute the next most expensive conditions--having generated estimated annual costs of $14.4 billion and $13.7 billion, respectively. Stroke, at $6.5 billion, follows in economic importance.