title: Four-fold increase in direct costs of stroke survivors with spasticity compared with stroke survivors without spasticity: the first year after the event.
abstract: OBJECTIVE
  The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no health economic studies on costs associated with spasticity after stroke. The objective of our study was to estimate direct costs of stroke with spasticity for patients surviving up to 1 year after the stroke event in comparison to costs of stroke without spasticity.
  
  
  METHODS
  A representative sample of patients with first-ever stroke hospitalized at Uppsala University Hospital was eligible for our cross-sectional survey. All direct costs during 1 year were identified for each patient, including costs for hospitalization (acute and rehabilitation), primary health care, medication, and costs for municipality services. Swedish currency was converted to Purchasing Power Parities US dollar (PPP$).
  
  
  RESULTS
  Median age (interquartile range) was 73 years (18), and the proportion of women was 48%. The majority of the direct costs (78%) was associated with hospitalization, whereas 20% was associated with municipality services during 1 year after a first-ever stroke. Only 1% of all direct costs were related to primary health care and 1% to medication. The level of costs for patients with stroke was correlated with the presence of spasticity as measured with the modified Ashworth scale (r(s)=0.524) and with the degree of disability as measured with modified Rankin Scale (r(s)=0.624). The mean (median, interquartile range) direct cost for stroke patients with spasticity was PPP$ 84,195 (72,116, 53,707) compared with PPP$ 21,842 (12,385, 17,484) for patients with stroke without spasticity (P<0.001).
  
  
  CONCLUSIONS
  Direct costs for 12-month stroke survivors are 4 times higher than direct costs for patients with stroke without spasticity during the first year after the event.
authors.affiliation: Departments of Neuroscience, Neurology and Rehabilitation Medicine, Uppsala University Hospital, Uppsala, Sweden. erik.lundstrom@gmail.com
authors.forename: Erik
authors.initials: E
authors.lastname: Lundström
authors.forename: Anja
authors.initials: A
authors.lastname: Smits
authors.forename: Jörgen
authors.initials: J
authors.lastname: Borg
authors.forename: Andreas
authors.initials: A
authors.lastname: Terént
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000925:Anticoagulants / Q000191:economics; D015897:Comorbidity; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D016527:Drug Costs; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics; D009111:Local Government; D008297:Male; D009128:Muscle Spasticity / Q000191:economics* / Q000401:mortality*; D020380:Needs Assessment / Q000191:economics; D017063:Outcome Assessment, Health Care / Q000191:economics; D010044:Outpatient Clinics, Hospital / Q000191:economics; D011320:Primary Health Care / Q000191:economics; D012046:Rehabilitation / Q000191:economics / Q000706:statistics & numerical data; D020521:Stroke / Q000191:economics* / Q000401:mortality*; D015996:Survival Rate; D017741:Survivors; D013548:Sweden / Q000453:epidemiology
chemical_list: D000925:Anticoagulants