An analysis of the costs of ischemic stroke in an Italian stroke unit

Objective: To determine the direct costs of hospital care of acute ischemic stroke in a large Italian hospital, and to identify the main components of such costs. Background: Cost containment in stroke care requires an up-to- date assessment of expenditures in the different areas of stroke management . However, costs may vary among countries because of different health syste m organizations. Methods: All patients with ischemic stroke admitted during 1996 were considered. Total cost was the sum of a daily component, reflect ing personnel wages and general care, and an ancillary component, reflectin g mostly investigations and treatments. The real costs were used, not fixed charges. Results: We included 245 patients, with a mean length of stay (LO S) of 13.1 +/- 7.0 days, and an in-hospital case fatality rate of 8.2%. The mean total cost per patient was 5,087,000 +/- 2,536,000 Italian Lira (LIT; $3,289 +/- $1,640), with a mean cost per day of 388,000 LIT ($251). Approx imately 80% of total costs were due to the daily component and 20% to the a ncillary component. A multiple linear regression model of length of stay, w hich determines the daily cost, showed that the Rankin score at entry, the clinical syndrome type, and the destination at discharge independently cont ributed to LOS. A second linear regression model showed that younger age an d longer LOS significantly increased ancillary costs. Conclusions: The cont ainment of hospital costs of ischemic stroke may be achieved mostly through measures that reduce LOS, such as effective treatments and a quicker deplo yment.