The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort

Abstract

Background: Despite increasing awareness of the long-term impact of pediatric stroke, there are few estimates of the costs of care. We examined acute and 5-year direct costs of neonatal and childhood stroke in a population-based cohort in Northern California.

Methods: We obtained electronic cost data for 266 children with neurologist-confirmed strokes, and 786 age-matched stroke-free controls, within the population of all children (<20 years) enrolled in a large managed care plan from 1996 through 2003. Cost data included all inpatient and outpatient health service costs including care at out-of-plan facilities. Costs were assessed for 5 years after stroke, expressed in 2003 US dollars, and stratified by age at stroke onset (neonatal, defined as <29 days of life, vs childhood). Stroke costs were adjusted for costs in stroke-free age-matched controls.

Results: Average adjusted 5-year costs for pediatric stroke are substantial: $51,719 for neonatal stroke and $135,161 for childhood stroke. The average cost of a childhood stroke admission was $81,869. The average birth admission cost for a neonatal stroke was $39,613; adjustment for control birth admission costs reduced this by only $4,792, suggesting the stroke accounted for 88% of costs. Even among neonates whose strokes were not recognized until later in childhood ("presumed perinatal strokes"), admission costs exceeded those of controls. Chronic costs were highest in the first year poststroke, but continued to exceed control costs even in the fifth year by an average of $2,016.

Conclusions: The economic burden of neonatal and childhood stroke is both large and sustained.

Figure Mean chronic costs after childhood stroke Annualized mean chronic costs in pediatric stroke subjects in Kaiser Permanente Medical Care Program from 1996 to 2003. Subjects are stratified into 3 groups: childhood ischemic stroke, childhood hemorrhagic stroke, and neonatal stroke (including presumed perinatal strokes). Year 1 costs exclude acute (admission) costs. Chronic costs of age-matched stroke-free control subjects are also shown. Values are in 2003 US dollars. Sample sizes, means, medians, and interquartile ranges for each data point are shown in table e-1.