Real-world costs of ischemic stroke by discharge status

Abstract

Objective: The objective of this study was to estimate the acute healthcare costs of ischemic stroke during hospitalization and the quarterly all-cause healthcare costs for the first year after discharge by discharge status.

Methods: Adult patients with a hospitalization with a diagnosis of ischemic stroke (ICD-9-CM: 434.xx or 436.xx) between 1 January 2006 and 31 March 2015 were identified from a large US commercial claims database. Patients were classified into three cohorts based on their discharge status from the first stroke hospitalization, i.e. dead at discharge, discharged with disability, or discharged without disability. Third-party (medical and pharmacy) and out-of-pocket costs were adjusted to 2015 USD.

Results: A total of 7919 patients dead at discharge, 45,695 patients discharged with disability, and 153,778 patients discharged without disability were included in this analysis. The overall average age was 59.7 years and 52.3% were male. During hospitalization, mean total costs (third-party and out-of-pocket) were $68,370 for patients dead at discharge, $73,903 for patients discharged with disability, and $24,448 for patients discharged without disability (p < .001 for each pairwise comparison); mean third-party costs were $63,605 for patients dead at discharge, $67,861 for patients discharged with disability and $19,267 for patients discharged without disability (p < .001 for each pairwise comparison). During the first year after discharge, mean total costs for patients discharged with disability vs. without disability were $46,850 vs. $30,132 (p < .001). Mean third-party costs for patients discharged with disability vs. without disability were $19,116 vs. $10,976 during the first quarter after discharge, $10,236 vs. $6926 during the second quarter, $8241 vs. $5810 during the third quarter, and $6875 vs. $5292 during the fourth quarter (p < .001 for each quarter).

Conclusion: The results demonstrated the high economic burden of ischemic stroke, especially among patients discharged with disability with the highest costs incurred during the inpatient stays.

Keywords:

• Healthcare costs
• health economics
• health insurance reimbursement
• stroke

Transparency

Declaration of funding

Funding for this research was provided by Genentech Inc.

Author contributions: Data was analyzed by Analysis Group Inc. and interpreted in collaboration with all other authors. The study sponsor was involved in all stages of the study research and manuscript preparation, but all authors participated in the design of the study and contributed to the manuscript development. All the authors vouch for the accuracy and completeness of the data reported and the adherence of the study to the protocol, and all the authors made the decision to submit the manuscript for publication.

Declaration of financial/other relationships

M.P. has disclosed that she/he is an employee of Genentech Inc. and owns stock/stock options. D.H. has disclosed that she/he is an independent consultant who has received consultancy fees from Genentech Inc. F.M., K.A.B., A.J.M., C.K. and E.Q.W. have disclosed that they are employees of Analysis Group Inc., which has received consultancy fees from Genentech Inc. to help conduct this study.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.