Estimating the lifetime economic burden of stroke according to the age of onset in South Korea: a cost of illness study

Abstract

BackgroundThe recently-observed trend towards younger stroke patients in Korea raises economic concerns, including erosion of the workforce. We compared per-person lifetime costs of stroke according to the age of stroke onset from the Korean societal perspective.MethodsA state-transition Markov model consisted of three health states ('post primary stroke event', 'alive post stroke', and 'dead') was developed to simulate the natural history of stroke. The transition probabilities for fatal and non-fatal recurrent stroke by age and gender and for non-stroke causes of death were derived from the national epidemiologic data of the Korean Health Insurance Review and Assessment Services and data from the Danish Monitoring Trends in Cardiovascular Disease study. We used an incidence-based approach to estimate the long-term costs of stroke. The model captured stroke-related costs including costs within the health sector, patients' out-of-pocket costs outside the health sector, and costs resulting from loss of productivity due to morbidity and premature death using a human capital approach. Average insurance-covered costs occurring within the health sector were estimated from the National Health Insurance claims database. Other costs were estimated based on the national epidemiologic data and literature. All costs are presented in 2008 Korean currency values (Korean won = KRW).ResultsThe lifetime costs of stroke were estimated to be: 200.7, 81.9, and 16.4 million Korean won (1,200 KRW is approximately equal to one US dollar) for men who suffered a first stroke at age 45, 55 and 65 years, respectively, and 75.7, 39.2, and 19.3 million KRW for women at the same age. While stroke occurring among Koreans aged 45 to 64 years accounted for only 30% of the total disease incidence, this age group incurred 75% of the total national lifetime costs of stroke.ConclusionsA higher lifetime burden and increasing incidence of stroke among younger Koreans highlight the need for more effective strategies for the prevention and management of stroke especially for people between 40 and 60 years of ages.

A Literature Review of Indirect Costs Associated with Stroke

“…Next, for estimating the productivity loss, there are two approaches: the human capital approach (HCA), which estimates forgone earnings due to stroke as the productivity loss, 12, 13 and the friction approach (FA), which assumes a friction cost, a cost associated with the replacement of workers including productivity losses due to substitution of workers or the training costs of new employees, as the productivity loss.…”

Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke

“…For women, it was estimated to be 75.7 million KRW at age 45, 39.2 million KRW at age 55, and 19.3 million KRW at age 65. While strokes in those 45-64 years of age accounted for only 30% of all strokes, this age group incurred 75% of the total national lifetime costs of stroke 30. However, the study might underestimate the lifetime cost since it did not consider the productivity loss of housewives and loss due to disability.…”

Friction Cost Estimates of Productivity Costs in Cost-of-Illness Studies in Comparison with Human Capital Estimates: A Review

“…For example, productivity costs in stroke patients were estimated in South Korea, Netherlands, United Kingdom, and Australia [56–59], and two studies examined productivity costs in multiple sclerosis [60, 61]. …”