title: Out-of-pocket costs for childhood stroke: the impact of chronic illness on parents' pocketbooks.
abstract: OBJECTIVE
  Direct costs for children who had stroke are similar to those for adults. There is no information regarding the out-of-pocket costs families encounter. We described the out-of-pocket costs families encountered in the first year after a child's ischemic stroke.
  
  
  METHODS
  Twenty-two subjects were prospectively recruited at four centers in the United States and Canada in 2008 and 2009 as part of the "Validation of the Pediatric NIH Stroke Scale" study; families' indirect costs were tracked for 1 year. Every 3 months, parents reported hours they did not work, nonreimbursed costs for medical visits or other health care, and mileage. They provided estimates of annual income. We calculated total out-of-pocket costs in US dollars and reported costs as a proportion of annual income.
  
  
  RESULTS
  Total median out-of-pocket cost for the year after an ischemic stroke was $4354 (range, $0-$28,666; interquartile range, $1008-$8245). Out-of-pocket costs were greatest in the first 3 months after the incident stroke, with the largest proportion because of lost wages, followed by transportation, and nonreimbursed health care. For the entire year, median costs represented 6.8% (range, 0%-81.9%; interquartile range, 2.7%-17.2%) of annual income.
  
  
  CONCLUSIONS
  Out-of-pocket expenses are significant after a child's ischemic stroke. The median costs are noteworthy provided that the median American household had cash savings of $3650 at the time of the study. These results with previous reports of direct costs provide a more complete view of the overall costs to families and society. Childhood stroke creates an under-recognized cost to society because of decreased parental productivity.
authors.affiliation: Department of Pediatrics, Neurology and Neurotherapeutics University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Patricia
authors.initials: P
authors.lastname: Plumb
authors.affiliation: Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio.
authors.forename: Eric
authors.initials: E
authors.lastname: Seiber
authors.affiliation: Department of Pediatrics, Neurology and Neurotherapeutics University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Dowling
authors.affiliation: Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: JoEllen
authors.initials: J
authors.lastname: Lee
authors.affiliation: Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Denver, Colorado.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Bernard
authors.affiliation: Division of Neurology, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: deVeber
authors.affiliation: Department of Neurology, Children's Hospital, Philadelphia, Pennsylvania.
authors.forename: Rebecca N
authors.initials: RN
authors.lastname: Ichord
authors.affiliation: Department of Neurology, Children's Hospital, Philadelphia, Pennsylvania.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastian
authors.affiliation: Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio. Electronic address: warren.lo@nationwidechildrens.org.
authors.forename: Warren D
authors.initials: WD
authors.lastname: Lo
mesh_terms: D000293:Adolescent; D002545:Brain Ischemia / Q000191:economics*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000191:economics; D017281:Cost of Illness; D005260:Female; D005102:Health Expenditures; D006801:Humans; D007223:Infant; D008297:Male; D010290:Parents; D010372:Pediatrics / Q000191:economics; D011446:Prospective Studies; D020521:Stroke / Q000191:economics*; D014481:United States
keywords: childhood ischemic stroke; indirect cost; out-of-pocket cost; pediatric stroke