Hospital cost of ischemic stroke and intracerebral hemorrhage in Japanese stroke centers.
BACKGROUND
In Japan, the healthcare expenditure has increased to 8.0% of the gross domestic products in 2001. Stroke care is costly.


OBJECTIVE
To examine hospital costs and clinical outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) in Japanese stroke centers.


METHODS
A prospective non-interventional multi-center study.


METHODS
Ten Japanese stroke centers.


METHODS
Fourteen months between October 2000 and December 2001.


METHODS
Patients were those who were consecutively hospitalized with acute IS or ICH within 72 h of onset, excluding subarachnoid hemorrhage. Stroke was defined as focal neurological deficits lasting more than 24 h and the relevant lesions were to be confirmed by brain CT and/or MRI.


METHODS
We examined demography, in-hospital cares, length of hospital stay, clinical outcomes at discharge, and direct hospital medical costs including physician's fees. The hospital medical cost data were collected from official hospital medical cost charts for reimbursement to the healthcare insurance systems.


RESULTS
There were a total of 1113 patients with a mean age of 70 years, of whom 913 (82%) patients had an IS and 200 (18%) patients had an ICH. The 317 patients (28%) experienced a recurrent stroke. Patients with ICH had the higher baseline stroke severity, resulting in longer hospitalization (39 days for IS and 46 days for ICH; P<0.001), lower independence rate at discharge (55 and 40%; P<0.001), higher mortality rate (5 and 10%; P=0.03), and higher medical costs (US dollar 8662 and US dollar 10,260; P<0.001) than those with IS. Patients with recurrent stroke had significantly older age, higher stroke severity, and lower independence rate at discharge than those with first-ever stroke. The length of stay, in-hospital mortality, and hospital medical costs were similar among first-ever and recurrent strokes. In subtype of IS, patients with cardioembolic stroke had the worst neurological deficits, poorest outcomes, and highest medical costs. The hospital costs had a greatest association with length of stay.


CONCLUSIONS
Stroke care is costly in Japan. ICH is more likely to impose substantial physical and economic burden than IS. Because the cares of both first-ever and recurrent stroke were costly, primary and secondary prevention of stroke is important on the healthcare aspects.
Yoneda
Yukihiro
Y
Division of Neurology, Hyogo Brain and Heart Center and Kobe Red Cross Hospital, 1-3-1 Wakihama Bay Street, Chuo-ku, Kobe 651-0073, Japan. y-yoneda@kobe.jrc.or.jp
Okuda
Satoshi
S
Hamada
Rikuzo
R
Toyota
Akihiro
A
Gotoh
Jun
J
Watanabe
Manabu
M
Okada
Yasushi
Y
Ikeda
Kiyonobu
K
Ibayashi
Setsuro
S
Hasegawa
Yasuhiro
Y
D000368:Aged; D002545:Brain Ischemia / Q000191:economics* / Q000453:epidemiology; D002543:Cerebral Hemorrhage / Q000191:economics* / Q000453:epidemiology; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D020521:Stroke / Q000191:economics* / Q000453:epidemiology