The use of mental health care facilities after stroke. A cost analysis.
OBJECTIVE
Although psychiatric comorbidity is relevant for a number of diseases, it is often ignored in technology assessment. This study examines the service use rate in mental healthcare facilities and related costs for stroke patients discharged from the University Hospital Maastricht between 1987 and 1995.


METHODS
Through anonymous record linkage, the medical registration of the hospital and the registration of the Maastricht Mental Health Care Register were linked.


RESULTS
Linkage succeeded for 16% of the 2,020 stroke patients, indicating that these patients used mental health services during a 10-year period around the stroke (+/- 5 years). Of the users' group, 88% had a mental healthcare contact following stroke. Regression analysis shows that age, length of hospital stay, and mental healthcare contact before stroke are associated with mental healthcare use after stroke. It is remarkable in that there is already an increase in the consumption of mental health care in the prodromal phase just before the stroke occurred. When comparing costs before and after stroke, the outpatient costs increased on average by [symbol: see text] 42.64, semi-institutionalized costs increased on average by [symbol: see text] 208.10, and intramural costs by [symbol: see text] 1,189.21. The total increase in costs is [symbol: see text] 1,439.95. For all mental healthcare facilities, the increase in costs is significant.


CONCLUSIONS
No study so far has revealed the total costs of mental healthcare facilities following stroke. Extrapolating these costs to the Netherlands illustrates that stroke patients have a high psychiatric comorbidity, inducing about 1.3% of total mental healthcare costs.
Evers
Silvia M A A
SM
Maastricht University, University Hospital at Maastricht.
Driessen
Ger A M
GA
Ament
André J H A
AJ
D000368:Aged; D003155:Community Mental Health Centers / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005852:Geriatric Psychiatry / Q000191:economics; D005858:Germany; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006778:Hospitals, Psychiatric / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000209:etiology / Q000628:therapy*; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D011567:Psychiatric Department, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D012044:Regression Analysis; D020521:Stroke / Q000150:complications* / Q000191:economics