10-year stroke costs higher than estimates project

It may be time to readjust lifetime financial costs for stroke patients. According to a 10-year follow-up in an Australian study, the annual price tag for treatment following stroke was higher than they’d previously estimated at year five.

Tristan D. Gloede, Dipl.-Ges.-Ök, from the University of Cologne in Germany, and colleagues in Australia returned to a patient sample at 10 years for clearer understanding of lifetime costs in stroke. The North East Melbourne Stroke Incidence Study (NEMESIS) team enrolled patients between 1996 and 1997 following an index stroke as part ofa  phase one pilot and extended enrollment in phase two between 1997 and 1999 to encompass a larger region.

The NEMESIS team then followed up with patients at three, six and 12 months and three, four and five years. Patients were interviewed again for this 10-year stage. Patient responses were then fed through a cost model developed in the earlier pilot.

They found that annual average direct costs were 24 percent higher at 10 years for patients with intracerebral hemorrhage than previously estimated using year three to five data ($7,607 vs. $5,807), although costs for ischemic stroke survivors remained close to expectations (around $5,207).

While the greatest annual financial cost was still in year one, costs did vary over time based on care needs. Direct annual ischemic stroke costs were approximately $5,207 at 10 years, marginally less than at three to five years ($5,438) with medications, care facilities and informal care contributing a greater amount to that cost in later years (13 percent at five years, 20 percent at 10 years). Medication and care facilities costs increased significantly, contributing to increased annual direct costs for intracerebral hemorrhage in year 10 compared to years three through five.

Average lifetime costs per case were greater following the 10-year data update. Ischemic stroke had previously been estimated at $51,806 and was found instead to be closer to $68,769 with the new data. At five years, the average lifetime costs per case for intracerebral hemorrhage had been estimated at $43,786, but amended with current data up to $54,956.

Gloede et al wrote that the take away was one of health policy and planning. With resource costs and patient burdens being high, stroke prevention and adequate support of stroke survivors was key.

In a press release, co-author Dominique Cadilhac, PhD, of Montash University in Victoria, Australia, said that while the costs involved in the care of stroke patients won’t go away, the study provides best evidence that pursuing modifiable risk factors was important. “We hope that our findings can be used to influence the need for more primary prevention and to also support assessment of the cost effectiveness of interventions to reduce disability from stroke. In addition, ensuring that the best evidenced-based guideline treatment is provided in hospitals will assist in reducing disability associated with stroke and may, in turn, avoid unnecessary aged-care placements or an undue burden to care givers.”

This study was published online Oct. 23 in Stroke.