title: Long-term costs of stroke using 10-year longitudinal data from the North East Melbourne Stroke Incidence Study.
abstract: OBJECTIVE
  Stroke is costly, although little is known about the long-term costs of survivors of stroke. In previous cost-of-illness studies, lifetime costs have been modeled based on estimates to 5 years after stroke. Building on previous work from the North East Melbourne Stroke Incidence Study (NEMESIS), we aimed to describe resource use at 10 years and recalculate the lifetime societal costs of ischemic and hemorrhagic (intracerebral hemorrhage) stroke.
  
  
  METHODS
  Ten-year patient-level resource use data were obtained and updated prices and population demographic statistics for 2010 were applied to our cost-of-illness models. We incorporated incidence data from a larger study region of NEMESIS than that used in the previous model and new 10-year survival and recurrent stroke rates. One-way sensitivity and probabilistic multivariable uncertainty analyses were undertaken.
  
  
  RESULTS
  For ischemic stroke, the overall average annual direct costs at 10 years (US dollars [USD] 5207) were comparable to those for survivors between 3 and 5 years (USD5438). However, the contribution of some costs varied (eg, medications contributed 13% at 5 years and 20% at 10 years). For intracerebral hemorrhage, annual direct costs were considerably (24%) greater at 10 years than estimated using 3 to 5 year data. Greater average lifetime costs per case were found using the updated models (ischemic stroke: previous model USD51806 and current USD68 769; intracerebral hemorrhage: previous model USD43 786 and current USD54 956 per case). Following sensitivity and multivariable uncertainty analyses, the findings were robust.
  
  
  CONCLUSIONS
  Costs to 10 years after stroke have not previously been reported. Our findings demonstrate the importance of estimating resource use over longer periods for forecasting lifetime estimates.
authors.affiliation: From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A.C.); Department of Neurology, Austin Health, Melbourne, Australia (H.M.D.); and Deakin Health Economics, Deakin University, Victoria, Australia (D.A.C.).
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Gloede
authors.affiliation: From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A.C.); Department of Neurology, Austin Health, Melbourne, Australia (H.M.D.); and Deakin Health Economics, Deakin University, Victoria, Australia (D.A.C.).
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Halbach
authors.affiliation: From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A.C.); Department of Neurology, Austin Health, Melbourne, Australia (H.M.D.); and Deakin Health Economics, Deakin University, Victoria, Australia (D.A.C.).
authors.forename: Amanda G
authors.initials: AG
authors.lastname: Thrift
authors.affiliation: From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A.C.); Department of Neurology, Austin Health, Melbourne, Australia (H.M.D.); and Deakin Health Economics, Deakin University, Victoria, Australia (D.A.C.).
authors.forename: Helen M
authors.initials: HM
authors.lastname: Dewey
authors.affiliation: From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A.C.); Department of Neurology, Austin Health, Melbourne, Australia (H.M.D.); and Deakin Health Economics, Deakin University, Victoria, Australia (D.A.C.).
authors.forename: Holger
authors.initials: H
authors.lastname: Pfaff
authors.affiliation: From the Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany (T.D.G., S.M.H., H.P.); Stroke and Ageing Research, School of Clinical Sciences, Monash University Clayton, Victoria, Australia (A.G.T., D.A.C.); Stroke Division, the Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia (A.G.T., H.M.D., D.A.C.); Department of Medicine, University of Melbourne, Parkville, Victoria, Australia (H.M.D., D.A.C.); Department of Neurology, Austin Health, Melbourne, Australia (H.M.D.); and Deakin Health Economics, Deakin University, Victoria, Australia (D.A.C.). dominique.cadilhac@monash.edu.
authors.forename: Dominique A
authors.initials: DA
authors.lastname: Cadilhac
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D020521:Stroke / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology*; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology
keywords: cerebral hemorrhage; cerebral infarction; cohort studies; costs and cost analysis