The One-Year Attributable Cost of Post-stroke Dysphagia

Abstract

With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies.

Effects of non-invasive brain stimulation on post-stroke dysphagia: A systematic review and meta-analysis of randomized controlled trials

“…This impact is staggering when the cost implications and morbidity of post-stroke dysphagia are considered. Stroke patients with dysphagia cost more to treat (about $4,510 more per patient than a stroke patient without dysphagia) because their hospital stay is nearly doubled, they require more therapy, and they have more complications with worse outcomes (Bonilha et al, 2014; Altman et al, 2010). Further, mortality is significantly higher in stroke patients with dysphagia; they have a 2.6-fold increased rate of death (Sharma et al, 2001; Smithard et al, 1996).…”

Recognizing the Importance of Dysphagia: Stumbling Blocks and Stepping Stones in the Twenty-First Century

“…Reasons for these dysphagia-driven cost increases are probably multifactorial. They may relate to an extended length of stay in hospital, higher rate of infectious complications, more frequent emergency room visits, larger proportion of patients discharged to rehabilitations settings and nursing homes, and higher costs for medical equipment and treatment [19]. …”

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

“…Furthermore, stroke-related mortality rises twofold if dysphagia is present [5]. With regards to the additional burden to the healthcare system, post-stroke dysphagia significantly increases medical expenses with 1-year costs p. p. being about USD 4,510 higher than for a patient without dysphagia, even when controlling for age, comorbidities, and proportion of time alive [6]. …”