Costs of health care and social services during the first year after ischemic stroke

Objectives: Knowledge of resource use and costs can be useful when evaluati ng existing services or planning new services. This study investigates the use of health care and social services during the first year after a stroke . Total costs are calculated, costs are compared across subgroups of patien ts, and resource items of major importance for the total costs are identifi ed. Methods: The study is based on a database comprising data on all stroke pat ients admitted to a university hospital in Copenhagen, Denmark, over al-yea r period, 1994-95. Patients were followed for 1 year after the stroke, and data on resource use during and after hospitalization were collected prospe ctively at interviews. This paper focuses on a subset of 385 patients who w ere admitted because of cerebral infarct or unspecified stroke. Results: The mean cost, based on ail patients, of health care and social se rvices during the first year was 142,900 DKK (US $25,500). The hospital car e until the first discharge, including acute care and rehabilitation, cost 101,600 Danish krones (DKK) (US $18,100), i.e., 71% of the total cost. Majo r resource items after discharge were nursing homes, readmissions, outpatie nt rehabilitation, and home help. The cost during the first year varied wit h a number of factors, with the most important being survival and degree of disability. Patients who survived the acute phase and who had severe disab ility (Barthel Activities of Dairy Living [ADL] Index: 0-9) 7-10 days after admission had a total cost during the first year that was five times as hi gh as patients with no disability (Barthel ADL Index: 20). Conclusion: Costs of health care and social services during the first year after a stroke vary considerably. Disability as measured with the Barthel A DL Index is a stronger predictor of costs than Scandinavian Stroke Scale sc ores and other clinical and demographic variables.