Hospital costs impact of post ischemic stroke dysphagia: Database analyses of hospital discharges in France and Switzerland

Abstract

IntroductionOropharyngeal dysphagia is frequent in hospitalized post-stroke patients and is associated with increased mortality and comorbidities. The aim of our analysis was to evaluate the impact of dysphagia on Length of Hospital Stay (LOS) and costs. The hospital perspective was used to assess costs.MethodsHospital discharge databases comparing hospital stays for ischemic stroke associated with dysphagia vs stroke without dysphagia in France and Switzerland were analyzed. The French Medical Information System Program (PMSI) database analysis focused on 62’297 stays for stroke in the public sector. 6’037 hospital stays for stroke were analyzed from the Swiss OFS (Office fédéral de la statistique: Statistique des coûts par cas 2012) database. Diagnosis codes and listing of procedures were used to identify dysphagia in stroke patients.ResultsPatients with post-stroke dysphagia accounted for 8.4% of stroke hospital stays in Switzerland, which is consistent with recently reported prevalence of dysphagia at hospital discharge (Arnold et al, 2016). The French database analysis identified 4.2% stays with post-stroke dysphagia. We hypothesize that the difference between the Swiss and French datasets may be explained by the limitations of an analysis based on diagnosis and procedure coding. Patients with post-stroke dysphagia stayed longer at hospitals (LOS of 23.7 vs. 11.8 days in France and LOS of 14.9 vs. 8.9 days in Switzerland) compared with patients without post-stroke dysphagia. Post-stroke dysphagia was associated with about €3’000 and CHF14’000 cost increase in France and Switzerland respectively.DiscussionIn this study post-stroke dysphagia was associated with increased LOS and higher hospital costs. It is difficult to isolate the impact of dysphagia in patients with multiple symptoms and disabilities impacting rehabilitation and recovery. After adjusting for confounding factors by matching stays according to age, sex and stroke complications, post-stroke dysphagia association with increased LOS and higher hospital costs was found to be independent of sensory or motor complications.ConclusionPost-stroke dysphagia is associated with increased length of hospital stay and higher hospital costs.

Healthcare-related cost of oropharyngeal dysphagia and its complications pneumonia and malnutrition after stroke: a systematic review

“… 22 For patients hospitalised in France and Switzerland after stroke an increase of €3000 and SFr14 000 was observed. 26 In the five studies reporting data on the cost of pneumonia after stroke, an adjusted effect of pneumonia on costs during hospitalisation after stroke was found to be between US$1456 and US$27 633 depending on the setting and the design of the study. 25–30 …”

“… 22–26 Two studies were performed in the USA, 22 23 two were performed in Taiwan, 24 25 and one was performed in France and Switzerland. 26 The US studies and the study performed in France and Switzerland were cost analysis studies 22 23 26 and the Taiwanese studies were cost prediction studies. 24 25 Incidence of OD ranged from 4.2% to 65.9%.…”

“…OD was associated with a significant increase in hospital costs during admission after adjusting for the presence of motor or/and sensory stroke complications (p<0.0001). 26 …”

“…Total scores for each study are available in table 1 and specific results for each study are available in the online supplementary appendix . Productivity losses secondary to the pathology were not assessed in any of the studies and quantities of consumed resources were only reported by Christensen et al and Muehlemann et al and separately from their unit costs 26 28 Methods for the estimation of quantities and units costs were barely described in the studies, the studies by Katzan et al and Christensen et al were the only ones to completely include them. 27–29 A sensitivity analysis was only offered in the studies by Christensen et al and Gomes et al .…”

Ausbildungscurriculum zum Zertifikat „Diagnostik und Therapie oropharyngealer Dysphagien, inklusive FEES“ der Deutschen Gesellschaft für Phoniatrie und Pädaudiologie und der Deutschen Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie

“…Zudem führen Dysphagien zu prolongierten Krankenhausaufenthalten, was z. B. für Schlaganfallpatienten nachgewiesen werden konnte [27,28]. Hieraus wird ersichtlich, dass Dysphagien und ihre Folgen zu einer erheblichen finanziellen Belastung der öffentlichen Gesundheitssysteme führen [29].…”