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Cost of stroke in Sweden: an incidence estimate
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2004 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 20, no 3, 375-380 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To estimate the excess cost of stroke in Sweden and the potential costs that could be avoided by preventing first-ever strokes.

METHODS: We adopted the incidence approach for estimating the present value of both direct and indirect costs. Data on mortality, stroke recurrence, and inpatient care were estimated from a national register of patient data with a four-year follow-up period. To estimate costs for social services, we used survey data on living conditions before stroke onset and at three and at twenty-four months. Costs for outpatient visits, rehabilitation, drugs, and production losses due to premature death and early retirement were estimated on the basis of both published and nonpublished sources. Lifetime costs were based on life tables adjusted for excess mortality of stroke, and costs in year 4 were extrapolated to subsequent years.

RESULTS: The present value direct cost for an average stroke patient is SEK 513,800 (USdollars 56,024 or Euro 60,825). The corresponding indirect cost is SEK 125,110 (USdollars 13,640 or Euro 14,810). Almost 45 percent of the direct costs were attributable to social services. Women had higher costs than men, and costs for survivors increased with age due to social services.

CONCLUSIONS: With an incidence of 213 first-ever strokes per 100,000 individuals, the total excess direct and indirect cost of stroke would be SEK 12.3 billion (approximately US$ 1.3 billion or Euro 1.5 billion). Hence, there are large potential cost offsets both in the health-care sector and in the social service sector if the incidence of first-ever stroke could be reduced.

Place, publisher, year, edition, pages
2004. Vol. 20, no 3, 375-380 p.
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-19201DOI: 10.1017/S0266462304001217PubMedID: 15446769OAI: oai:DiVA.org:umu-19201DiVA: diva2:201555
Available from: 2009-03-05 Created: 2009-03-05 Last updated: 2013-10-07Bibliographically approved
In thesis
1. The burden of stroke in Sweden: studies on costs and quality of life based on Riks-Stroke, the Swedish stroke register
Open this publication in new window or tab >>The burden of stroke in Sweden: studies on costs and quality of life based on Riks-Stroke, the Swedish stroke register
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The costs for stroke management and reduced health related quality of life (QoL) can extend throughout life as mental and physical disabilities are common. The aim of this thesis was to quantify this stroke-related burden with data from Riks-Stroke (RS), the Swedish stroke register.

Costs for hospital and primary care, secondary drug prevention, home and residential care services, and production losses were estimated for first-ever stroke patients registered in the RS. The present value lifetime costs were estimated from the expected survival and discounted by 3%. Quality of life was estimated with the EQ-5D instrument on a subset of patients at 3 months after the index event and mapped to patient-reported outcome measures in the RS. Standard descriptive and analytic (multivariate regressions) statistical methods were used.

The life-time societal present value cost per patient in 2009 was approximately €69,000 whereof home and residential care due to stroke was 59% and indirect costs for productivity losses accounted for 21% (year 2009 prices). Women had higher costs than men in all age groups. Treatment at stroke units had a low incremental cost per life-year gained compared to patients who were not treated at such facilities. The estimated disutility from stroke was greatest for women and the oldest, and compared to 1997 the cost per patient increased after a revised assumption. Hospitalisation costs were stable while long-term costs for ADL support increased in part due to a changed age structure. Patients with atrial fibrillation (AF; 24%) had €367 higher inpatient costs compared to non-AF stroke patients €8,914 (P<0.01; year 2001 prices). As the index case fatality was higher among AF patients, the cost difference was higher for patients surviving the first 28 days. A multivariate regression showed that AF, diabetes, stroke severity, and death during the 3-year follow-up period were independent cost drivers. Three regression techniques (OLS, Tobit, CLAD) were chosen for mapping EQ-5D utilities to patient-reported outcome measures in the RS. The mean utility was overestimated with all models and had lower variance than the original data.

In conclusion, total societal lifetime cost for 22,000 first-ever stroke patients in 2009 amounted to €1.5 billion (whereof production losses were €314 million). About 56,600 QALYs were lost due to premature death and disability. Including a preference-based QoL instrument in the RS would allow cost-utility analyses, but it is important to control for confounders in comparator arms to avoid bias.

Place, publisher, year, edition, pages
Umeå: Umeå university, 2013. 47 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1587
Keyword
Stroke, atrial fibrillation, cost of illness, utility, mapping, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
hälso- och sjukvårdsforskning
Identifiers
urn:nbn:se:umu:diva-80917 (URN)978-91-7459-707-3 (ISBN)
Public defence
2013-10-31, Hörsal D, Unod T9, Umeå Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-10-07 Created: 2013-09-28 Last updated: 2014-07-21Bibliographically approved

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Ghatnekar, OlaGlader, Eva-Lotta

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