title: Hospital-based study of the care and cost of acute ischemic stroke in Japan.
abstract: OBJECTIVE
  To evaluate the current status of care and cost of acute ischemic stroke in Japan, we performed a hospital-based analysis at a tertiary emergency hospital with a 24-hour neurology-neurosurgery team and care unit.
  
  
  METHODS
  During the 12-month period of October 2000 to September 2001, we collected data on 179 patients consecutively hospitalized with acute ischemic stroke within 7 days of onset. We examined demographic data, in-hospital care, length of hospital stay, outcome at discharge, and hospital costs. The medical cost data were collected from official hospital medical cost charts, which calculated direct medical costs for beds, staff, examinations, medications, and rehabilitation.
  
  
  RESULTS
  The mean age was 70 years, and 69% were male. Hospital arrival was within 3 hours of onset in 30% of the patients. A history of stroke was present in 37%. The mean initial National Institutes of Health Stroke Scale score was 8.3 points (median, 6 points). Using the Trial of Org 10172 in Acute Stroke Treatment classification, 25% were lacunar, 27% were atherothrombotic, 33% were cardioembolic, and 15% were of unknown origin. All patients underwent neuroimaging studies during hospitalization; 96% and 92% underwent CT and MRI with MR angiography, respectively. Antithrombotic medications were given in 94%, none of whom received thrombolysis. A newly licensed neuroprotective agent, edaravone, was given in 16%. More than half of the patients (55%) were initially admitted to the neurological intensive care unit. Overall, 64% received in-hospital rehabilitation. Mean length of stay was 33 days. In-hospital mortality rate was 3%. On the modified Rankin Scale (mRS), 63% were independent (mRS, 0 to 2) and 34% were dependent (mRS, 3 to 5) at discharge. Two thirds of the patients (65%) went directly back home. The mean hospital cost per patient was $6887 ($209/d), of which 69% was attributable to the costs for beds and staff, 12% for medications, 7% for rehabilitation, 6% for imaging studies, 5% for laboratory examinations, and 1% for other costs.
  
  
  CONCLUSIONS
  Despite the single hospital-based analysis, this study provided current, precise data on short-term inpatient care and costs of acute ischemic stroke in Japan. Because stroke often carries a permanent dependence, long-term cost-effective stroke care should be established.
authors.affiliation: Neurology Service, Hyogo Brain and Heart Center at Himeji, 520 Saisho-ko, Himeji 670 - 0981, Japan. yyoneda@hbhc.jp
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yoneda
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Uehara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamasaki
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Kita
authors.forename: Masayasu
authors.initials: M
authors.lastname: Tabuchi
authors.forename: Etsuro
authors.initials: E
authors.lastname: Mori
mesh_terms: D000208:Acute Disease / Q000191:economics; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010043:Outcome and Process Assessment, Health Care / Q000191:economics* / Q000706:statistics & numerical data*; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data
chemical_list: D005343:Fibrinolytic Agents; D018696:Neuroprotective Agents