Study: Enhancing acute stroke care can decrease costs
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Treating stroke patients with timely acute care decreases the level of disability in stroke survivors and the need for long-term care, in turn trimming costs, according to an economic analysis of the total costs of stroke and transient ischemic attack (TIA) in Ireland published Dec. 1 in Age and Aging.

“Information on the prevalence-based costs of different illnesses can inform health policy makers when setting priorities, evaluating existing services, allocating resources and planning new services,” Samantha Smith, of the Economic and Social Research Institute in Dublin, and colleagues wrote. “The Irish context is of particular interest, giving an example of a healthcare system where stroke services remain relatively underdeveloped and where there is a complex mix of public and private provision, with implications for the composition of the cost burden.”

To better outline the economic burdens of stroke and TIA in Ireland in 2007, Smith et al estimated total costs of stroke and TIA in 2007 using the North Dublin Population Stroke Study (NDPSS).

The researchers estimated direct total costs of stroke to be €489 million (USD $656.3 million) to €805 million (USD $1.08 billion) in 2007, comprising €345 million (USD $463.3 million) to €557 million (USD $748.2 million) in direct costs and €143 million (USD $192 million) to €248 million (USD $333.1 million) in indirect costs. According to the authors, nursing home care accounted for more than 44 percent of total costs.

Additionally, productivity losses from stroke morbidity/mortality accounted for 20 percent of costs, hospital care accounted for nearly 10 percent and informal care accounted for almost 9 percent.

Out of pocket expenses accounted for 19 percent of the total and 79 percent of these costs were publicly funded.

The researchers estimated that total costs of TIA to be nearly €11.1 million (USD $14.9 million) in 2007; €9.9 million (USD $13.3 million) for acute hospital care and €1.1 million (USD $1.5 million) for medications.

“Relatively high levels of disability amongst stroke survivors in Ireland have been observed in United Kingdom–Ireland comparisons,” according to Smith et al. “This may partly reflect the fact that while effective treatments are available to reduce acute stroke morbidity and mortality (e.g. stroke unit care, thrombolysis and rehabilitation), these services are not universally provided in Ireland and this may be contributing to a greater need for long-term care.”

Nursing home and indirect costs accounted for the largest portion of total stroke costs, stressing the importance of improving outcomes after acute stroke to both reduce the cost burden and improve patients’ quality of life.

“In the Irish case, there are indications that current nursing home costs are higher than they might otherwise be if more timely acute care reduced the level of disability in stroke survivors and associated need for long-term care,” Smith and colleagues wrote. “Conversely, given the deficiencies in nursing home and community rehabilitation services, it is likely that the current expenditure levels are lower than they should be if adequate levels of rehabilitation were made available.”

The researchers summed that further studies should be conducted to pinpoint the reasons for these costs.

The study was funded by the Irish Heart Foundation.