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Impact of Disability Status on Ischemic Stroke Costs in Canada in the First Year

Published online by Cambridge University Press:  02 December 2014

Nicole Mittmann ,
Soo Jin Seung ,
Michael D. Hill ,
Stephen J. Phillips ,
Vladimir Hachinski ,
Robert Coté ,
Brian H. Buck ,
Ariane Mackey ,
David J. Gladstone  and
David C. Howse
...Show all authors
Nicole Mittmann*
Affiliation:
Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Health Sciences Centre Department of Pharmacology, University of Toronto International Centre for Health Innovation, Richard Ivey Business School, Western University
Soo Jin Seung
Affiliation:
Health Outcomes and PharmacoEconomics (HOPE) Research Centre, Sunnybrook Health Sciences Centre
Michael D. Hill
Affiliation:
Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary
Stephen J. Phillips
Affiliation:
Medicine (Neurology), Dalhousie University, Halifax, Nova Scotia
Vladimir Hachinski
Affiliation:
University of Western Ontario, London
Robert Coté
Affiliation:
Department of Neurology and Neurosurgery, McGill University, Montreal, Montreal
Brian H. Buck
Affiliation:
Division of Neurology, Faculty of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
Ariane Mackey
Affiliation:
Department of Medicine, Laval University, Quebec City, Quebec
David J. Gladstone
Affiliation:
Regional Stroke Prevention Clinic, Sunnybrook Health Sciences Centre
David C. Howse
Affiliation:
Regional Stroke Program, Thunder Bay Regional Health Sciences Centre-Medical Centre, Thunder Bay
Ashfaq Shuaib
Affiliation:
Division of Neurology, Faculty of Internal Medicine, University of Alberta, Edmonton, Alberta, Canada
Mike Sharma
Affiliation:
Division of Neurology, University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario
*
HOPE Research Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Aveune, E240, Toronto, Ontario, M4N 3M5, Canada. Email: nicole.mittmann@sri.utoronto.ca
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Abstract

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Background:

Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs.

Methodology:

The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): non-disabling stroke (mRS 0-2) and disabling stroke (mRS 3-5).

Results:

We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes.

Conclusions:

An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A “back of the envelope” calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.

Résumé

RÉSUMÉ Contexte:

Nous n'avons pas de données longitudinales sur l'utilisation des ressources par les patients et les coûts ainsi engendrés suite à un accident vasculaire cérébral (AVC) ischémique au Canada. Les buts de cette analyse étaient de calculer les coûts engendrés au cours de la première année après un AVC et de déterminer l'impact de l'invalidité sur ces coûts.

Méthode:

Le Economic Burden of Ischemic Stroke (BURST) Study est une étude prospective d'une durée de un an chez une cohorte de patients ayant subi un AVC ischémique qui ont été recrutés dans 12 centres canadiens de traitement de l'AVC. Des informations ont été recueillies sur l'histoire clinique, l'invalidité, les choix de santé et l'utilisation des ressources au moment du congé hospitalier, trois mois, six mois et un an plus tard. Les ressources incluaient les coûts médicaux directs (en $ canadiens 2009) comme les services d'urgence, les hospitalisations, la réadaptation, les frais médicaux, diagnostiques et thérapeutiques, les autres services professionnels, les soins à domicile, les équipements médicaux/accessoires fonctionnels, les changements effectués au lieu de résidence et les aidants rémunérés ainsi que les coûts indirects. Les résultats ont été stratifiés selon l'invalidité telle que mesurée au moment du congé hospitalier au moyen du modified Rankin Score (mRS): AVC non invalidant (mRS 0-2) et AVC invalidant (mRS 3-5).

Résultats:

Nous avons recruté 232 patients atteints d'un AVC ischémique, dont l'âge moyen était de 69,4 ± 15,4 ans et dont 51,3% étaient des hommes. Cent treize (48,7%) étaient invalides au moment du congé hospitalier. Le coût annuel moyen était de 74 353$, soit 107 883$ pour un AVC entraînant une invalidité et 48 339$ pour un AVC n'entraînant pas d'invalidité.

Conclusions:

Nous avons calculé le coût annuel moyen attribuable à un AVC ischémique et nous avons constaté qu'un AVC invalidant était associé à un coût qui est le double de celui d'un AVC non invalidant. Les coûts engendrés pendant l'hospitalisation et les trois premiers mois étaient ce qui contribuait le plus au coût annuel. À grande échelle, le fardeau annuel de l'AVC pour 38 000 hospitalisations pour AVC s'élève à un coût annuel moyen de 2,8 milliards de dollars.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 6 , November 2012 , pp. 793 - 800
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1. The Internet Stroke Center. Stroke Statistics [Internet]. Dallas: Internet Stroke Center, UT Southwestern Medical Center, Department of Neurology and Neurotherapeutics; c1997-2012 [updated 2012; cited 2012 May 14]. Available from: http://www.strokecenter.org/patients/about-stroke/stroke-statistics/ Google Scholar
2. Talyor, TN, Davis, PH, Torner, JC, Holmes, J, Meyer, JW, Jacobson, MF. Lifetime cost of stroke in the United States. Stroke. 1996;27 (9):1459–66.Google Scholar
3. Saka, O, McGuire, A, Wolfe, C. Cost of stroke in the United Kingdom. Age Aging. 2009;38(1):27–32.Google Scholar
4. Dewey, HM, Thrift, AG, Mihalopoulos, C, et al. Lifetime cost of stroke subtypes in Australia: findings from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2003;34(10):2502–7.Google Scholar
5. Chan, B, Hayes, B. Cost of stroke in Ontario, 1994/95. Can Med Assoc J. 1998;159(6 Suppl.):S2–S8.Google Scholar
6. Christensen, MC, Previgliano, I, Capparelli, FJ, Lerman, D, Lee, WC, Wainsztein, NA. Acute treatment costs of intracerebral hemorrhage and ischemic stroke in Argentina. Acta Neurol Scand. 2009;119(4):246–53.Google Scholar
7. Luengo-Fernandez, R, Gray, AM, Rothwell, PM. Costs of stroke using patient-level data: a critical review of the literature. Stroke. 2009;40(2):e18–e23.CrossRefGoogle Scholar
8. Collin, C, Wade, DT, Davies, S, Horne, V. The Barthel ADL Index: a reliability study. Int Disability Studies. 1988;10(2):61–3.Google Scholar
9. Wilson, JT, Hareendran, A, Hendry, A, Potter, J, Bone, I, Muir, KW. Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. Stroke. 2005;36(4):777–81.Google Scholar
10. Josephson, SA, Hills, NK, Johnston, SC. NIH Stroke Scale reliability in ratings from a large sample of clinicians. Cerebrovasc Dis. 2006;22(5–6):389–95.Google Scholar
11. Horsman, J, Furlong, W, Feeny, D, Torrance, G. The Health Utilities Index (HUI): concepts, measurement properties and applications. Health Qual Life Outcomes. 2003;1(54):1–13.Google Scholar
12. Williams, JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiat. 1988;45(8):742–7.Google Scholar
13. Sunnybrook Health Sciences Centre. Drug formulary [Internet]. Toronto: Sunnybrook Health Sciences Centre; c2008 [cited 2010 Aug 17]. Available from: http://drugformulary/drugsearch.cfm Google Scholar
14. Government of Ontario. Ministry of Health and Long Term Care [homepage on the Internet]. Toronto: Queen’s Printer for Ontario; c2008. Ontario Health Insurance (OHIP) Schedule of benefits and fees [modified 2012 May 11; cited 2010 Aug 17]. Available from: http://www.health.gov.on.ca/english/providers/program/ohip/sob/sob_mn.html Google Scholar
15. Government of Ontario. Ministry of Health and Long Term Care. [homepage on the Internet]. Toronto: Queen’s Printer for Ontario; c2008. Ambulance service charges [updated 2012 Jan 12; cited 2010 Aug 17]. Available from: http://www.health.gov.on.ca/english/public/program/ehs/land/service_qa.html Google Scholar
16. Ontario Case Costing Initiative (OCCI). OCCI Costing Analysis Tool [Internet]. Toronto: Ontario Case Costing Initiative; [updated 2011 Jun; cited 2010 Aug 17]. Available from: http://www.occp.com/mainPage.htm Google Scholar
17. Government of Canada. Labour Market Information [Internet]; Ottawa: Government of Canada; [updated 2009; cited 2010 Aug 17]. Available from: http://www.labourmarketinformation.ca/standard.aspx?ppid=82 Google Scholar
18. West Park Healthcare Centre. West Park Healthcare Centre [homepage on the Internet]. [Toronto (ON)]: West Park Healthcare Centre; [updated 2012 Apr 16]. Community Report; 2005 Nov 5 [cited 2010 Aug 17]. Available from: http://www.westpark.org/media/PDF/CommRep_Nov05web.pdf Google Scholar
19. Statistics Canada. Statistics Canada [homepage on the Internet]. Ottawa: Statistics Canada; [modified 2012 Apr 30]. Table 2 Average hourly wages of employees aged 15 and older, job permanence and union coverage, by sex, Canada, annual, 1998 to 2008 [modified 2010 Mar 8; cited 2010 Aug 17]. Available from: http://www.statcan.gc.ca/pub/11-008-x/2010001/t/11133/tbl002-eng.htm Google Scholar
20. Homewell Seniors Care. Senior Care Services [Internet]. Seattle: Homewell Senior Care, Inc.; c2010 [cited 2010 Aug 17]. Available from: http://www.homewellseniorcare.com/services/care-services.php Google Scholar
21. Registered Massage Therapists’ Association of Ontario. Advancing the profession for a healthier you [homepage on the Internet]. Etobicoke: Registered Massage Therapists’ Association of Ontario; c2012. Understanding massage therapy and fees; [cited 2010 Aug 17]. Available from: http://www.rmtao.com/Massage_Therapy/your_massage_dollars/understanding_rmt_fees.htm Google Scholar
22. Ontario Chiropractic Association (OCA). Home [homepage on the Internet]. Toronto: OCA; c2012. OCA recommended fee schedule; 2012 Jan 1 [cited 2010 Aug 17]. Available from: http://d2oovpv43hgkeu.cloudfront.net/publicresources/oca_recommended_fee_schedule.pdf Google Scholar
23. Pedorthic Association of Canada. Experts in custom orthotics to relieve sore feet caused by metetarsalgia, overprotonation, plantar fasciitis, heel pain [homepage on the Internet]. Winnipeg: Pedorthic Association of Canada; c2012. Position statement on custom-made footwear and stock orthopaedic footwear; [updated 2011 Oct 24; cited 2010 Aug 17]. Available from: http://www.pedorthic.ca/files/CustomFootwearWebsite_000.pdf Google Scholar
24. Discount, Ramps. Loading ramps, hauling, transport, & skateborading ramp superstore [homepage on the Internet]. West Bend: Discount Ramps. Com; c2000-2012. Portable & fixed mobility wheelchair ramps; [cited 2010 Aug 17]. Available from: http://www.discountramps.com/wheelchair-ramps.htm Google Scholar
25. 2 Care 4 Medical Ltd. Medical supplies equipment [homepage on the Internet]. Smith Falls: 2 Care 4 Medical Ltd; c2012. Stairlifts [cited 2010 Aug 17]. Available from: http://www.2care4medical.com/index.cfm?&CFID=41682208&CFTOKEN=58264111 Google Scholar
26. Invacare. Leading manufacturer of home and long term care products [homepage on the Internet]. Elyria: Invacare Corp.; c2012. Products & services; [updated 2012, May 17; cited 2010 Aug 17]. Available from: http://www.invacare.com/cgi-bin/imhqprd/default.jsp Google Scholar
27. The Home Depot. Home improvement, home renovation, tools & hardware [homepage on the Internet]. City unknown: Homer TLC Inc.; c2012. Bath safety; [cited 2010 Aug 17]. Available from: http://www.homedepot.ca/catalog/bath-safety/173266 Google Scholar
28. Koziol, JA, Feng, AC. On the analysis and interpretation of outcome measures in stroke clinical trials: lessons from the SAINT I study of NXY-059 for acute ischemic stroke. Stroke. 2006;37(10):2644–7.Google Scholar
29. Saver, JL, Gornbein, J. Treatment effects for which shift or binary analyses are advantageous in acute stroke trials. Neurology. 2009;72(15):1310–15.Google Scholar
30. Shuaib, A, Lees, KR, Lyden, P, et al. NXY-059 for the treatment of acute ischemic stroke. N Engl J Med. 2007;357(6):562–71.Google Scholar
31. Cadilhac, DA, Carter, R, Thrift, AG, Dewey, HM. Estimating the long-term costs of ischemic and hemorrhagic stroke for Australia: new evidence derived from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2009;40(3):915–21.Google Scholar
32. Goeree, R, Blackhouse, G, Petrovic, R, Salama, S. Cost of stroke in Canada: a 1-year prospective study. J Med Econ. 2005;8(1–4):147–67.Google Scholar
33. Smurawska, LT, Alexandrov, AV, Bladin, CF, Norris, JW. Cost of acute stroke care in Toronto, Canada. Stroke. 1994;25(8):1628–31.Google Scholar
34. Kapral, MK, Fang, J, Hill, MD, et al. Sex differences in stroke care and outcomes: results from the Registry of the Canadian Stroke Network. Stroke. 2005;36(4):809–14.Google Scholar
35. Canadian Stroke Network. Canadian Stroke Network [homepage on the Internet]. Ottawa: Canadian Stroke Network; 2011. The quality of stroke care in Canada; 2011 Jun 16 [cited 2011 Jul 11]. Available from: http://www.canadianstrokenetwork.ca/index.php5/news/the-quality-of-stroke-care-in-canada-2011/ Google Scholar
36. Sweileh, WM, Sawalha, AF, Zyoud, SH, Al-Jabi, SW, Abaas, MA. Discharge medications among ischemic stroke survivors. J Stroke Cerebrovasc Dis. 2009;18(2):97–102.Google Scholar
37. O’Donnell, MJ, Xavier, D, Liu, L, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376(9735):112–23.Google Scholar