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Costs for stroke in Sweden 2009 and developments since 1997
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.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
2014 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 30, no 2, 203-209 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim of this study was to estimate direct and indirect excess costs attributable to stroke in Sweden in 2009 and to compare these with similar estimates from 1997. Methods: Data on first-ever stoke admissions in the first half of 2009 from the Swedish national stroke register (RS) were used for cost calculations and compared with results from 1997 also using RS data. A societal perspective was taken including the acute and follow-up phase, rehabilitation, stroke re-admissions, drugs, home-and residential care services for activities of daily life (ADL) support, and indirect costs for premature death and productivity losses (2009 prices). Survival was extrapolated to estimate the lifetime present value cost of stroke. Results: The societal lifetime present value cost for stroke in 2009 was (sic)68,800 per patient (ADL support: 59 percent; productivity losses: 21 percent). Women had higher costs than men in all age groups as a result from greater need for ADL support. Patients treated at a stroke unit indicated low incremental cost per life-year gained compared with those who had not. The total lifetime cost increased between 1997 and 2009. Hospitalization costs per patient were stable, while long-term costs for home-and residential care services increased. Conclusions: Changes in patient characteristics, longer expected survival, and possibly in the Swedish stroke care, have led to higher annual and lifetime costs per patient in 2009 compared with 1997. A comprehensive national stroke care performance register like RS may be suitable for health economic assessments.

Place, publisher, year, edition, pages
2014. Vol. 30, no 2, 203-209 p.
Keyword [en]
Stroke, Cost of illness, Technology assessment, Stroke units, Sweden
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
URN: urn:nbn:se:umu:diva-91228DOI: 10.1017/S0266462314000075ISI: 000337738300010OAI: oai:DiVA.org:umu-91228DiVA: diva2:734786
Note

Included in thesis in manuscript form, with the title "The societal cost of stroke in Sweden 2009 and its development since 1997".

Available from: 2014-07-21 Created: 2014-07-21 Last updated: 2017-12-05Bibliographically 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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