Impact of Disability Status on Ischemic Stroke Costs in Canada in the First Year

Background: Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs. Methodology: The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): non-disabling stroke (mRS 0-2) and disabling stroke (mRS 3-5). Results: We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes. Conclusions: An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A “back of the envelope” calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.

[1]  Saudi Arabia,et al.  in the United States and in , 1981 .

[2]  D. Wade,et al.  The Barthel ADL Index: a reliability study. , 1988, International disability studies.

[3]  Janet B W Williams,et al.  A structured interview guide for the Hamilton Depression Rating Scale. , 1988, Archives of general psychiatry.

[4]  A. Alexandrov,et al.  Cost of Acute Stroke Care in Toronto, Canada , 1994, Stroke.

[5]  J. Holmes,et al.  Lifetime cost of stroke in the United States. , 1996, Stroke.

[6]  B. Chan,et al.  Cost of stroke in Ontario, 1994/95 , 1998 .

[7]  J. McNeil,et al.  Lifetime Cost of Stroke Subtypes in Australia: Findings From the North East Melbourne Stroke Incidence Study (NEMESIS) , 2003, Stroke.

[8]  D. Feeny,et al.  The Health Utilities Index (HUI®): concepts, measurement properties and applications , 2003, Health and quality of life outcomes.

[9]  Clare Bradley,et al.  Not-only-a-title , 2003, Health and quality of life outcomes.

[10]  Jan Potter,et al.  Reliability of the Modified Rankin Scale Across Multiple Raters: Benefits of a Structured Interview , 2005, Stroke.

[11]  R. Goeree,et al.  Cost of stroke in Canada: a 1-year prospective study , 2005 .

[12]  F. Silver,et al.  Sex Differences in Stroke Care and Outcomes: Results From the Registry of the Canadian Stroke Network , 2005, Stroke.

[13]  S. Johnston,et al.  NIH Stroke Scale Reliability in Ratings from a Large Sample of Clinicians , 2006, Cerebrovascular Diseases.

[14]  J. Koziol,et al.  On the Analysis and Interpretation of Outcome Measures in Stroke Clinical Trials , 2006 .

[15]  J. Koziol,et al.  On the Analysis and Interpretation of Outcome Measures in Stroke Clinical Trials: Lessons From the SAINT I Study of NXY-059 for Acute Ischemic Stroke , 2006, Stroke.

[16]  Hans-Christoph Diener,et al.  NXY-059 for the treatment of acute ischemic stroke. , 2007, The New England journal of medicine.

[17]  Rob Carter,et al.  Estimating the Long-Term Costs Of Ischemic and Hemorrhagic Stroke for Australia: New Evidence Derived From the North East Melbourne Stroke Incidence Study (NEMESIS) , 2009, Stroke.

[18]  J. Gornbein,et al.  Treatment effects for which shift or binary analyses are advantageous in acute stroke trials , 2009, Neurology.

[19]  I. Previgliano,et al.  Acute treatment costs of intracerebral hemorrhage and ischemic stroke in Argentina , 2009, Acta neurologica Scandinavica.

[20]  S. Zyoud,et al.  Discharge medications among ischemic stroke survivors. , 2009, Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association.

[21]  C. Wolfe,et al.  Cost of stroke in the United Kingdom. , 2008, Age and ageing.

[22]  P. Rothwell,et al.  Costs of Stroke Using Patient-Level Data: A Critical Review of the Literature , 2009, Stroke.

[23]  S. Yusuf,et al.  Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study , 2010, The Lancet.