title: Direct costs of patients with stroke can be continuously monitored on a national level: performance, effectiveness, and Costs of Treatment episodes in Stroke (PERFECT Stroke) Database in Finland.
abstract: OBJECTIVE
  Treatment of stroke consumes a significant portion of all healthcare expenditure. We developed a system for monitoring costs from individual patient data on a national level in Finland.
  
  
  METHODS
  Multiple national administrative registers were linked to gain episode-of-care data on all hospital-treated patients with incident stroke over the years 1999 to 2007 (n = 94,316). Inpatient and specialist outpatient costs were evaluated with a cost database, long-term care costs with fixed prices, and medication costs with true retail prices.
  
  
  RESULTS
  For the patients of Year 2007, the mean 1-year costs after an ischemic stroke were $29 580, after an intracerebral hemorrhage $36,220, and after a subarachnoid hemorrhage $42,570, valued in Year 2008 U.S. dollars. Only part of these costs are attributable to stroke, because the annual costs prior to stroke were significant, $8900 before ischemic stroke, $7600 before intracerebral hemorrhage, and $4200 before subarachnoid hemorrhage. Older patients with ischemic stroke, and, among patients with ischemic stroke and subarachnoid hemorrhage, women, incurred higher costs. The mean estimated lifetime costs were $130,000 after ischemic stroke or intracerebral hemorrhage and $80,000 after subarachnoid hemorrhage. Annually $1.6 billion is spent in the care of Finnish patients with stroke, which equals to 7% of the national healthcare expenditure, or 0.6% of the gross domestic product. Costs of patients with stroke are increasing with prolonged survival and the aging population.
  
  
  CONCLUSIONS
  Treatment of patients with stroke is a large national investment. Setting up a nationwide system for continuous monitoring of stroke costs is feasible. Cost data should optimally be evaluated in conjunction with effectiveness and performance indicators.
authors.affiliation: Department of Neurology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 HUS, Finland. atte.meretoja@fimnet.fi
authors.forename: Atte
authors.initials: A
authors.lastname: Meretoja
authors.forename: Markku
authors.initials: M
authors.lastname: Kaste
authors.forename: Risto O
authors.initials: RO
authors.lastname: Roine
authors.forename: Merja
authors.initials: M
authors.lastname: Juntunen
authors.forename: Miika
authors.initials: M
authors.lastname: Linna
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
authors.forename: Reijo
authors.initials: R
authors.lastname: Marttila
authors.forename: Terttu
authors.initials: T
authors.lastname: Erilä
authors.forename: Aimo
authors.initials: A
authors.lastname: Rissanen
authors.forename: Juhani
authors.initials: J
authors.lastname: Sivenius
authors.forename: Unto
authors.initials: U
authors.lastname: Häkkinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000191:economics; D016208:Databases, Factual; D004470:Economics, Medical; D005260:Female; D005387:Finland; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D012042:Registries; D020521:Stroke / Q000191:economics* / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000191:economics