title: Does warfarin-related intracerebral haemorrhage lead to higher costs of management?
abstract: OBJECTIVE
  Warfarin-related intracerebral haemorrhage is associated with significant morbidity but long term treatment costs are unknown. Our study aimed to assess the cost of warfarin-related intracerebral haemorrhage.
  
  
  METHODS
  We included all patients with intracerebral haemorrhage between July 2006 and December 2011 at a single centre. We collected data on anticoagulant use, baseline clinical variables, discharge destinations, modified Rankin Scale at discharge and in-hospital costings. First year costings were extracted from previous studies. Multiple linear regression for treatment cost was performed with stratified analysis to assess for effect modification.
  
  
  RESULTS
  There were 694 intracerebral haemorrhage patients, with 108 (15.6%) previously on warfarin. Mean age (SD) of participants was 70.3 (13.6) and 58.5% were male. Patients on warfarin compared to those not on warfarin had significantly lower rates of discharge home (12.0% versus 18.9%, p=0.013). Overall total costs between groups were similar, $AUD 25,767 for warfarin-related intracerebral haemorrhage and $AUD 27,388 for non-warfarin intracerebral haemorrhage (p=0.353). Stratified analysis showed survivors of warfarin-related intracerebral haemorrhage had higher costs compared to those without warfarin ($AUD 33,419 versus $AUD 30,193, p<0.001) as well as increased length of stay (12 days versus 8 days, p<0.001). Inpatient mortality of patients on warfarin was associated with a shorter length of stay (p=0.001) and lower costs.
  
  
  CONCLUSIONS
  Survival of initial haemorrhage on warfarin was associated with increased treatment cost and length of stay but this was discounted by higher rates and earlier nature of mortality in warfarinised patients.
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Jeremy K
authors.initials: JK
authors.lastname: Kam
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia.
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Chen
authors.affiliation: Department of Medicine, University of Melbourne, Melbourne, Australia; Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia. Electronic address: bernard.yan@mh.org.au.
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000191:economics; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000191:economics / Q000401:mortality; D005260:Female; D017721:Hospital Costs; D017052:Hospital Mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014859:Warfarin / Q000009:adverse effects* / Q000191:economics
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Cost; Intracerebral haemorrhage; Mortality; Stroke; Warfarin