Long-Term Costs of Stroke Remain HIgh

A/Prof Dominique Cadilhac, MPH PhD Head: Translational Public Health Division Stroke and Ageing Research Centre (STARC) Department of Medicine, School of Clinical Sciences at Monash Health, Monash University Melbourne, AustraliaMedicalResearch.com Interview with:
A/Prof Dominique Cadilhac, MPH PhD
Head: Translational Public Health Division
Stroke and Ageing Research Centre (STARC)
Department of Medicine,
School of Clinical Sciences at Monash Health, Monash University
Melbourne, Australia

Medical Research: What are the main findings of the study?

Dr. Cadilhac: Our results provide important information for health policy and planning, by providing a better understanding of the long-term costs of ischemic stroke (IS) and intracerebral hemorrhage stroke (ICH).

243 patients who experienced an ischemic stroke– the most common type of stroke, and 43 patients with intracerebral hemorrhage stroke who went on to survive for 10 years or more were interviewed to calculate annual costs as part of the North East Melbourne Stroke Incidence Study. Average annual healthcare costs 10 years after an ischemic stroke were $5,418 (AUD) – broadly similar to costs estimated between 3 and 5 years ($5,545). Whereas previous estimates for annual healthcare costs for intracerebral hemorrhage stroke ten years after stroke onset were $6,101, Professor Cadilhac’s team found the true cost was $9,032 far higher than costs calculated at 3 to 5 years ($6,101) because of a greater need for aged care facilities 10 years on.

The high lifetime costs per stroke for both subtypes for first-ever events emphasize the significant economic implications of stroke (ischemic stroke AUD103,566 [USD 68,769] and intracerebral hemorrhage stroke AUD82,764 [USD54,956]).

The study also provides evidence of the importance of updating cost estimates when population demography patterns change or if new information on incidence rates, or case-fatality rates, are available. We found a much larger number of intracerebral hemorrhage stroke would be expected than from earlier estimates because
a) there are a larger number of people in the age groups 45 to 84 years living in Australia in 2010; and
b) we applied new information on incidence rates from a larger geographical region than what was found from using the original NEMESIS pilot study region. In the online supplement we also provide an estimate of health loss reported as quality adjusted Life years (QALYs) lost to highlight how many years of healthy life is lost from a first-ever stroke event.

Medical Research: What was most surprising about the results?

Dr. Cadilhac We found that with the exception of inpatient rehabilitation use for ischemic stroke, many of the annual costs to treat a stroke survivor at 3 to 5 years are similar to those at 10 years.

Previous studies based on estimating the lifetime costs using patient data up to 5 years after a stroke, suggested that costs peaked in the first year and then declined in subsequent years. Our new findings, provides evidence that healthcare and personal expenses associated with a stroke continue to be substantial over time. Our study revealed the most important direct cost categories at 10-years were aged care facilities, informal care, and medications. Use of medications and rehabilitation are the resources that changed the most in the long-term, however further work is required to better determine these changes for intracerebral hemorrhage stroke.

Medical Research: What should clinicians and patients take away from your report?

Dr. Cadilhac The study was conducted to provide new and important information to decision-makers, clinicians, survivors of stroke and the public on the full spectrum of stroke costs over time. Many cost studies ignore costs to patients, their caregivers and broader impacts on work force participation and household productivity. These data provide important current practice estimates for future economic evaluations of the potential impact of new or existing interventions. Therefore, these data can serve a variety of purposes for health planning and policy decision-making.

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. The large portion of resource use in the long-term is driven by aged care and informal care. Ensuring the best treatment (according to evidence-based clinical guidelines) is provided in hospital will assist in reducing disability associated with stroke and, may in turn, avoid unnecessary aged care placements or an undue burden to caregivers.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. CadilhacThis study provides support for the need to focus efforts on prevention of stroke and focus research on determining the most effective programs for prevention, since the costs of providing care to people who suffer stroke are unlikely to diminish. There is good evidence that investing in prevention will not outweigh the cost of treating major cardiovascular events, such as stroke. Much could be gained if we could work to prevent the large majority of strokes that are due to modifiable risk factors, such as high blood pressure or diabetes.

Ensuring patients receive best practice care in hospital, which is essential for reducing disability, such as access to Stroke Care Units, is also vital. Research that supports trialling new interventions or ensuring greater uptake of effective interventions that will reduce disability should also be a priority.

We have not yet examined the data according to gender separately. We did account for differentials in age and gender throughout the cost analysis, but do not report these data separately. This may be an important next stage in this work.


Long-Term Costs of Stroke Using 10-Year Longitudinal Data
From the North East Melbourne Stroke Incidence Study

Tristan D. Gloede, Sarah M. Halbach, Amanda G. Thrift, Helen M. Dewey, Holger Pfaff, and Dominique A. Cadilhac

Stroke. 2014;STROKEAHA.114.006200published online before print October 23 2014, doi:10.1161/STROKEAHA.114.006200