Inpatient Cost of Stroke Care in Greece: Preliminary Results of the Web-Based “SUN4P” Registry

Abstract

The aim of this study was to calculate the average operational cost per sub-type of stroke patient and to investigate cost drivers (e.g. ALoS, NIHSS score, age) correlated to cost. Methods: Direct medical costs (diagnostic imaging and clinical laboratory exams, overheads/bed cost, pharmaceuticals, ringers and other non-durables and inpatient rehabilitation) per patient were calculated from the providers’ (hospitals’) perspective. Resource use data derived from the “SUN4P” web-based registry and unit costs were retrieved from publically available sources and were assigned to resource use. Results: The sample comprised 6,282 inpatient days of 750 patients (mean age: 75.5±13.3 years) admitted from July 2019 to July 2021, in nine public hospitals. Mean length of stay was 8.4±7.6 days and mean total operational cost was calculated to €1,239.4 (from which 45% and 35% related to diagnostic exams and overheads/bed cost respectively). Mean cost related to hemorrhagic stroke patients that were discharged alive was calculated significantly higher compared to mean cost related to ischemic stroke patients who didn’t undertake thrombolysis and were also discharged alive from the hospital (€2,155.2 vs. €945.2, p<0.001). Linear regression analysis revealed that length of stay was significantly correlated with cost (coefficient beta=232, 95% CI confidence interval = 220–243, p<0.001). Conclusions: These findings are in accordance with current evidence and should be thoroughly assessed to rationalize inpatient reimbursement rates in order to achieve improved value of care.

The Cost and the Value of Stroke Care in Greece: Results from the SUN4P Study

“…Regarding non-healthcare costs, prior studies have extensively documented the impact of stroke on both patients and their relatives or informal caregivers’ productivity losses [ 8 , 12 , 19 ]. Our analysis corroborated these findings, revealing significant productivity loss within the first year following a stroke.…”

“…The major components that we took into consideration were: (i) Loss of patients’ productivity due to morbidity (absenteeism from work, early retirement, loss of work) (ii) Loss of patients’ productivity due to mortality (iii) Loss of family members’ productivity due to informal caregiving. To measure the loss of productivity due to morbidity and mortality, we employed the human capital approach [ 12 ].…”

“…Using survey data, the total burden of stroke for Greece in 2017 was estimated at EUR 650 million, of which EUR 284 million (43.7%) was allocated to direct medical costs, while the remaining costs were attributed to loss of productivity, informal/unpaid, and social care [ 8 ]. Several Greek studies have calculated the direct medical cost of stroke, primarily focusing on inpatient acute care [ 10 , 11 , 12 ]. However, no study was found that comprehensively calculated the burden of stroke throughout the care cycle using real-world data in Greece.…”

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“…The cost of inpatient stroke care varies greatly depending on stroke type and diagnosis status. Linear regression analysis showed that the length of hospital stay was significantly correlated with cost (beta coefficient = 232, 95% CI = 220–243, p < 0.001) [ 14 ]. A comparative analysis of the outcomes of stroke patients in urban and rural hospitals in Australia found that patients admitted to rural hospitals were less likely to receive thrombolysis compared to urban hospitals (7.5% in rural hospitals vs. 12.7% in urban hospitals, p < 0.001), while it was also noted that fewer patients were discharged with a planned care appointment (61.3% in urban areas compared to 44.7% in rural areas, p < 0.001) [ 15 ].…”