title: The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort.
abstract: BACKGROUND
  Despite increasing awareness of the long-term impact of pediatric stroke, there are few estimates of the costs of care. We examined acute and 5-year direct costs of neonatal and childhood stroke in a population-based cohort in Northern California.
  
  
  METHODS
  We obtained electronic cost data for 266 children with neurologist-confirmed strokes, and 786 age-matched stroke-free controls, within the population of all children (<20 years) enrolled in a large managed care plan from 1996 through 2003. Cost data included all inpatient and outpatient health service costs including care at out-of-plan facilities. Costs were assessed for 5 years after stroke, expressed in 2003 US dollars, and stratified by age at stroke onset (neonatal, defined as <29 days of life, vs childhood). Stroke costs were adjusted for costs in stroke-free age-matched controls.
  
  
  RESULTS
  Average adjusted 5-year costs for pediatric stroke are substantial: $51,719 for neonatal stroke and $135,161 for childhood stroke. The average cost of a childhood stroke admission was $81,869. The average birth admission cost for a neonatal stroke was $39,613; adjustment for control birth admission costs reduced this by only $4,792, suggesting the stroke accounted for 88% of costs. Even among neonates whose strokes were not recognized until later in childhood ("presumed perinatal strokes"), admission costs exceeded those of controls. Chronic costs were highest in the first year poststroke, but continued to exceed control costs even in the fifth year by an average of $2,016.
  
  
  CONCLUSIONS
  The economic burden of neonatal and childhood stroke is both large and sustained.
authors.affiliation: Department og Pediatrics, University of California, San Francisco, Department of Neurology, San Francisco, CA 94143-0114, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Gardner
authors.forename: N K
authors.initials: NK
authors.lastname: Hills
authors.forename: S
authors.initials: S
authors.lastname: Sidney
authors.forename: S C
authors.initials: SC
authors.lastname: Johnston
authors.forename: H J
authors.initials: HJ
authors.lastname: Fullerton
mesh_terms: D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018672:Community Health Planning; D003365:Costs and Cost Analysis / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D020380:Needs Assessment / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000191:economics; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000453:epidemiology