title: The cost of first-ever stroke in Valle d'Aosta, Italy: linking clinical registries and administrative data.
abstract: BACKGROUND
  Stroke is one of the most relevant reasons of death and disability worldwide. Many cost of illness studies have been performed to evaluate direct and indirect costs of ischaemic stroke, especially within the first year after the acute episode, using different methodologies.
  
  
  METHODS
  We conducted a longitudinal, retrospective, bottom-up cost of illness study, to evaluate clinical and economic outcomes of a cohort of patients affected by a first cerebrovascular event, including subjects with ischaemic, haemorrhagic or transient episodes. The analysis intended to detect direct costs, within 1, 2 and 3 years from the index event. Clinical patient data collected in regional disease registry were integrated and linked to regional administrative databases to perform the analysis.
  
  
  RESULTS
  The analysis of costs within the first year from the index event included 800 patients. The majority of patients (71.5%) were affected by ischaemic stroke. Overall, per patient costs were €7,079. Overall costs significantly differ according to the type of stroke, with costs for haemorrhagic stroke and ischaemic stroke amounting to €9,044 and €7,289. Hospital costs, including inpatient rehabilitation, were driver of expenditure, accounting for 89.5% of total costs. The multiple regression model showed that sex, level of physical disability and level of neurological deficit predict direct healthcare costs within 1 year. The analysis at 2 and 3 years (per patient costs: €7,901 and €8,874, respectively) showed that majority of costs are concentrated in the first months after the acute event.
  
  
  CONCLUSIONS
  This cost analysis highlights the importance to set up significant prevention programs to reduce the economic burden of stroke, which is mostly attributable to hospital and inpatient rehabilitation costs immediately after the acute episode. Although some limitation typical of retrospective analyses the approach of linking clinical and administrative database is a power tool to obtain useful information for healthcare planning.
authors.affiliation: Department of Neurology, Regional Hospital of Aosta Valley, Aosta, Italy. ebottacchi@ausl.vda.it
authors.forename: Edo
authors.initials: E
authors.lastname: Bottacchi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corso
authors.forename: Piera
authors.initials: P
authors.lastname: Tosi
authors.forename: Massimo Veronese
authors.initials: MV
authors.lastname: Morosini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Filippis
authors.forename: Laura
authors.initials: L
authors.lastname: Santoni
authors.forename: Gianluca
authors.initials: G
authors.lastname: Furneri
authors.forename: Cristina
authors.initials: C
authors.lastname: Negrini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017281:Cost of Illness; D005260:Female; D006302:Health Services Research; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D008498:Medical Record Linkage; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000453:epidemiology