A cost analysis of the first year after stroke - early triage and inpatient rehabilitation may reduce long term costs.
OBJECTIVE
To analyse the costs of stroke in the first year covered by insurance companies and to correlate them with the clinical outcome data.


METHODS
We contacted the insurance companies of 172 consecutive stroke patients of a single institution cohort for a detailed report of the stroke costs. A complete data set over one year was obtained from 131 patients (76%).


RESULTS
Severity of stroke was significantly associated with increasing total costs (p = 0.0002). The rehabilitation clinic made up 37% of the total costs followed by nursing home with 21% and acute hospital with 21%. Mean cost of stroke per patient was 31,115 CHF in the first year. Costs per patient for inpatient rehabilitation were similar to those for the nursing home after one year; however, the Barthel-index of patients with inpatient rehabilitation increased by 42 +/- 29 points as compared to patients without inpatient rehabilitation by 23 +/- 26 points (p <0.05), and 86% resp. 81% of patients with inpatient stroke rehabilitation lived independently after 6 and 12 months respectively.


CONCLUSIONS
The high level of independence after inpatient stroke rehabilitation underlines the importance of patient selection and/or rehabilitation. Therefore, long-term stroke costs may be significantly reduced by an early and careful triage in the case management after stroke and a case-dependent investment in initial costly appearing inpatient rehabilitation.
Mahler
M-P
MP
argomed Arzte AG, Baden-Dättwil, Switzerland. mp.mahler@hin.ch
Züger
K
K
Kaspar
K
K
Haefeli
A
A
Jenni
W
W
Leniger
T
T
Beer
J H
JH
D000368:Aged; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006305:Health Status Indicators; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007297:Inpatients; D008297:Male; D011446:Prospective Studies; D020521:Stroke / Q000188:drug therapy / Q000191:economics*; D000071939:Stroke Rehabilitation; D013557:Switzerland; D013997:Time Factors; D014218:Triage