Costs to treat bleeding strokes increases 10 years later

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Costs to treat strokes caused by bleeding in the brain may increase significantly 10 years later, according to a study in the American Heart Association journal Stroke. The Australian study is the first to include 10 years of follow-up data on stroke cost estimates.

Generally, expenses associated with a stroke peak within the first year and decline over time. Previous estimates of lifetime costs in Australia were based on a five-year average and may have underestimated costs, specifically for haemorrhagic strokes.

“Prevention of stroke should be a focus, since the costs of providing care to people who suffer stroke are unlikely to diminish,” says Dominique Cadilhac, study senior author and an associate professor and head of the Translational Public Health: Stroke and Ageing Research Centre at Monash University in Victoria, Australia. “Much could be gained if we could work to prevent the majority of strokes that are due to modifiable risk factors, such as high blood pressure or diabetes.”

Researchers interviewed 243 ischemic stroke patients and 43 intracerebral haemorrhage patients who had survived for 10 years or more. The patients had participated in an earlier Australian regional study that estimated five-year costs.

Researchers found that:

  • Average annual direct costs for ischaemic stroke remained stable between five to 10 years at about US$5,207.
  • Average annual direct costs for intracerebral haemorrhage stroke increased 31%, from US$5,807 at five years to US$7,607 at 10 years and the overall average lifetime costs per case for intracerebral haemorrhage stroke increased 25%, from US$43,786 to US$54,956.
  • Medication, aged-care facilities and informal care expenses explained the majority of costs at 10 years. Rehabilitation expenses decreased for ischemic stroke.

“We did not know that the cost differentials would be so great between ischaemic stroke and interecerebral haemorrhage and that short-term estimates (six-12 months after a first stroke) used to approximate lifetime annual resource use after the first year would not be a good predictor of future costs,” says Cadilhac, who is also the head of public health and epidemiology within the Stroke Division of the Florey Institute of Neuroscience and Mental Health and Data Custodian for the Australian Stroke Clinical Registry.

The Australian healthcare system is funded through public and private health insurance. However, the way health care is delivered and priced may influence cost differences between the two health systems. For example, if patients in America stay in the hospital longer or are offered different rehabilitation choices to what is available in Australia, estimates may be too low or high.

“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,” Cadilhac comments. “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 caregivers.”