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Impact of Disability Status on Ischemic Stroke Costs in Canada in the First Year

Published online by Cambridge University Press:  02 December 2014

Nicole Mittmann
Affiliation:
Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Health Sciences Centre Department of Pharmacology, University of Toronto International Centre for Health Innovation, Richard Ivey Business School, Western University
Soo Jin Seung
Affiliation:
Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Health Sciences Centre
Michael D. Hill
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary
Stephen J. Phillips
Affiliation:
Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia
Vladimir Hachinski
Affiliation:
University of Western Ontario, London
Robert Coté
Affiliation:
Department of Neurology and Neurosurgery, McGill University, Montreal, Montreal
Brian H. Buck
Affiliation:
Division of Neurology, Faculty of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
Ariane Mackey
Affiliation:
Department of Medicine, Laval University, Quebec City, Quebec
David J. Gladstone
Affiliation:
Regional Stroke Prevention Clinic, Sunnybrook Health Sciences Centre
David C. Howse
Affiliation:
Regional Stroke Program, Thunder Bay Regional Health Sciences Centre-Medical Centre, Thunder Bay
Ashfaq Shuaib
Affiliation:
Division of Neurology, Faculty of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
Mike Sharma
Affiliation:
Division of Neurology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario
Corresponding
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Abstract

Background:

Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs.

Methodology:

The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): non-disabling stroke (mRS 0-2) and disabling stroke (mRS 3-5).

Results:

We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes.

Conclusions:

An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A “back of the envelope” calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.

Résumé

RÉSUMÉ Contexte:

Nous n'avons pas de données longitudinales sur l'utilisation des ressources par les patients et les coûts ainsi engendrés suite à un accident vasculaire cérébral (AVC) ischémique au Canada. Les buts de cette analyse étaient de calculer les coûts engendrés au cours de la première année après un AVC et de déterminer l'impact de l'invalidité sur ces coûts.

Méthode:

Le Economic Burden of Ischemic Stroke (BURST) Study est une étude prospective d'une durée de un an chez une cohorte de patients ayant subi un AVC ischémique qui ont été recrutés dans 12 centres canadiens de traitement de l'AVC. Des informations ont été recueillies sur l'histoire clinique, l'invalidité, les choix de santé et l'utilisation des ressources au moment du congé hospitalier, trois mois, six mois et un an plus tard. Les ressources incluaient les coûts médicaux directs (en $ canadiens 2009) comme les services d'urgence, les hospitalisations, la réadaptation, les frais médicaux, diagnostiques et thérapeutiques, les autres services professionnels, les soins à domicile, les équipements médicaux/accessoires fonctionnels, les changements effectués au lieu de résidence et les aidants rémunérés ainsi que les coûts indirects. Les résultats ont été stratifiés selon l'invalidité telle que mesurée au moment du congé hospitalier au moyen du modified Rankin Score (mRS): AVC non invalidant (mRS 0-2) et AVC invalidant (mRS 3-5).

Résultats:

Nous avons recruté 232 patients atteints d'un AVC ischémique, dont l'âge moyen était de 69,4 ± 15,4 ans et dont 51,3% étaient des hommes. Cent treize (48,7%) étaient invalides au moment du congé hospitalier. Le coût annuel moyen était de 74 353$, soit 107 883$ pour un AVC entraînant une invalidité et 48 339$ pour un AVC n'entraînant pas d'invalidité.

Conclusions:

Nous avons calculé le coût annuel moyen attribuable à un AVC ischémique et nous avons constaté qu'un AVC invalidant était associé à un coût qui est le double de celui d'un AVC non invalidant. Les coûts engendrés pendant l'hospitalisation et les trois premiers mois étaient ce qui contribuait le plus au coût annuel. À grande échelle, le fardeau annuel de l'AVC pour 38 000 hospitalisations pour AVC s'élève à un coût annuel moyen de 2,8 milliards de dollars.

Type
Original Articles
Copyright
Copyright © The Canadian Journal of Neurological 2012

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