Short- and longer-term health-care resource utilization and costs associated with acute ischemic stroke

Abstract

ObjectivesThe mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS).MethodsThis retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index) between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS) were described in the year postindex.ResultsThe eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively) in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6%) of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively) of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days) and Medicare beneficiaries (4.0 vs 10.8 days).ConclusionIn addition to the substantial costs of the initial hospitalization of an AIS, these costs double within the year following this event. Given the high cost associated with AIS, new interventions reducing either the acute or longer-term burden of AIS are needed.

Financial Burden of Stroke Reflected in a Pilot Center for the Implementation of Thrombolysis

“…Despite the evidence that long-term costs are substantial, few studies have quantified short-term and long-term direct costs [23,24]. Studies that systematically evaluated readmission after stroke have shown that patients with a more severe form of the disease have higher readmission rates both at 30 and 90 days [25,26]. Also, re-hospitalizations are more frequent in the elderly, one of the studies indicating relatively high readmission rates, 25-39% within 30 days [25].…”

“…Studies that systematically evaluated readmission after stroke have shown that patients with a more severe form of the disease have higher readmission rates both at 30 and 90 days [25,26]. Also, re-hospitalizations are more frequent in the elderly, one of the studies indicating relatively high readmission rates, 25-39% within 30 days [25]. In another recent study on 307,887 patients with insurance in the public health system who suffered an ischemic stroke, 14.4% of patients had readmissions within 30 days after discharge [25,26].…”

Global Burden of Stroke

“…7 lifetime cost of ischemic stroke per person, which includes inpatient care, rehabilitation, and follow-up care, is estimated at $140,048 in the United States. 9 The total annual direct costs were estimated at €26.6 billion in 2010 for the European Union (EU) plus Iceland, Norway, and Switzerland. 10 The economic burden caused by stroke has not been well explored in developing countries; according to estimates by the World Health Organization (WHO), India, for example, lost $8.7 billion in 2005 due to coronary heart disease (CHD), stroke, and diabetes.…”

Cost-effectiveness of percutaneous closure of a patent foramen ovale compared with medical management in patients with a cryptogenic stroke: from the US payer perspective

“…Model assumptions, resource utilization, and unit cost data were acquired from numerous sources as described in Table 1. The latest healthcare expenses accounting for treatment and physician costs, longterm care, as well as first-year medical device costs were primarily derived from RED BOOK and the Centers for Medicare & Medicaid Services, as well as several other relevant published data sources (Table 1) 17,18 . For the purpose of this model, outcomes were expressed as costs using 2018 USD ($) per quality-adjusted life-year (QALY).…”