Association between disability measures and healthcare costs after initial treatment for acute stroke.
OBJECTIVE
The distribution of 3-month modified Rankin scale (mRS) scores has been used as an outcome measure in acute stroke trials. We hypothesized that hospitalization and institutional care home stays within the first 90 days after stroke should be closely related to 90-day mRS, that each higher mRS category will reflect incremental cost, and that resource use may be less clearly linked to the National Institutes of Health Stroke Scale (NIHSS) or Barthel index.


METHODS
We examined resource use data from the GAIN International trial comparing 90-day mRS with total length of stay in hospital or other institutions during the first 90 days. We repeated analyses using NIHSS and Barthel index scores. Relationships were examined by analysis of variance (ANOVA) with Bonferroni contrasts of adjacent score categories. Estimated costs were based on published Scottish figures.


RESULTS
We had full data from 1717 patients. Length of stay was strongly associated with final mRS (P<0.0001). Each mRS increment from 0 to 1-2 to 3-4 was significant (mean length of stay: 17, 25, 44, 58, 79 days; P<0.0005). Ninety-five percent confidence limits for estimated costs ( pound) rose incrementally: 2493 to 3412, 3369 to 4479, 5784 to 7008, 7300 to 8512, 10 095 to 11 141, 11 772 to 13 560, and 2623 to 3321 for mRS 0 to 5 and dead, respectively. Weaker relationships existed with Barthel and NIHSS.


CONCLUSIONS
Each mRS category reflects different average length of hospital and institutional stay. Associated costs are meaningfully different across the full range of mRS outcomes. Analysis of the full distribution of mRS scores is appropriate for interpretation of treatment effects after acute stroke and more informative than Barthel or NIHSS end points.
Dawson
Jesse
J
Department of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. j.dawson@clinmed.gla.ac.uk
Lees
Jennifer S
JS
Chang
Tou-Pin
TP
Walters
Matthew R
MR
Ali
Myzoon
M
Davis
Stephen M
SM
Diener
Hans-Christoph
HC
Lees
Kennedy R
KR
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D015337:Multicenter Studies as Topic; D017063:Outcome Assessment, Health Care; D016032:Randomized Controlled Trials as Topic / Q000191:economics; D012720:Severity of Illness Index; D020521:Stroke / Q000191:economics* / Q000453:epidemiology*; D013997:Time Factors