LIFETIME COST OF STROKE IN THE UNITED-STATES

Background and Purpose Stroke imposes a substantial economic burden on individuals and society. This study estimates the Lifetime direct and indirect costs associated with the three major types of stroke: subar achnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (ISC). Methods We developed a model of the lifetime cost of in cident strokes occurring in 1990. An epidemiological model of stroke i ncidence, survival, and recurrence was developed based on a review of the literature. Data on direct cost of treating stroke were obtained f rom Medicare claims data, the 1987 National Medical Expenditure Survey (NMES), and insurance claims data representing a group of large, self -insured employers. Indirect costs (the value of foregone market and n onmarket production) associated with premature morbidity and mortality were estimated based on data from the US Bureau of Economic Analysis and the 1987 NMES. Results The lifetime cost per person of first strok es occurring in 1990 is estimated to be $228 030 for SAH, $123 565 for ICH, $90 981 for ISC. and $103 576 averaged across all stroke subtype s. Indirect costs accounted for 58.0% of Lifetime costs. Aggregate lif etime cost associated with an estimated 392 344 first strokes in 1990 was $40.6 billion: $5.6 billion for SAH, $6.0 billion for ICH, and $29 .0 billion for ISC. Acute-care costs incurred in the 2 years following a first stroke accounted for 45.0%, long-term ambulatory carl account ed for 35.0%, and nursing home costs accounted for 17.5% of aggregate lifetime costs of stroke. Conclusions The lifetime cost of stroke vari es considerably by type of stroke and entails considerable costs beyon d the first 2 years after a stroke.