The cost of first-ever stroke in Valle d'Aosta, Italy: linking clinical registries and administrative data

Abstract

Background: Stroke is one of the most relevant reasons of death and disability worldwide. Many cost of illness studies have been performed to evaluate direct and indirect costs of ischaemic stroke, especially within the first year after the acute episode, using different methodologies.

Methods: We conducted a longitudinal, retrospective, bottom-up cost of illness study, to evaluate clinical and economic outcomes of a cohort of patients affected by a first cerebrovascular event, including subjects with ischaemic, haemorrhagic or transient episodes. The analysis intended to detect direct costs, within 1, 2 and 3 years from the index event. Clinical patient data collected in regional disease registry were integrated and linked to regional administrative databases to perform the analysis.

Results: The analysis of costs within the first year from the index event included 800 patients. The majority of patients (71.5%) were affected by ischaemic stroke. Overall, per patient costs were €7,079. Overall costs significantly differ according to the type of stroke, with costs for haemorrhagic stroke and ischaemic stroke amounting to €9,044 and €7,289. Hospital costs, including inpatient rehabilitation, were driver of expenditure, accounting for 89.5% of total costs. The multiple regression model showed that sex, level of physical disability and level of neurological deficit predict direct healthcare costs within 1 year. The analysis at 2 and 3 years (per patient costs: €7,901 and €8,874, respectively) showed that majority of costs are concentrated in the first months after the acute event.

Conclusions: This cost analysis highlights the importance to set up significant prevention programs to reduce the economic burden of stroke, which is mostly attributable to hospital and inpatient rehabilitation costs immediately after the acute episode. Although some limitation typical of retrospective analyses the approach of linking clinical and administrative database is a power tool to obtain useful information for healthcare planning.

Figure 1

Structure of database linkage*.

Figure 2

Distribution of patients according to Barthel index at hospital admission and discharge (n=667).

Figure 3

Distribution of patients according to NIHSS scores at hospital admission and discharge (n=667).

Figure 4

Kaplan-Meier survival analysis to determine time to death.

Figure 5

Kaplan-Meier survival analysis to determine time to death or fatal or non-fatal cardio-cerebrovascular event.

Figure 6

Average annual costs, by type of stroke.

Figure 7

Per patient costs, at 1, 2 and 3 years from index date.