Hospital costs of ischemic stroke and TIA in the Netherlands.
OBJECTIVE
There have been no ischemic stroke costing studies since major improvements were implemented in stroke care. We therefore determined hospital resource use and costs of ischemic stroke and TIA in the Netherlands for 2012.


METHODS
We conducted a retrospective cost analysis using individual patient data from a national diagnosis-related group registry. We analyzed 4 subgroups: inpatient ischemic stroke, inpatient TIA, outpatient ischemic stroke, and outpatient TIA. Costs of carotid endarterectomy and costs of an extra follow-up visit were also estimated. Unit costs were based on reference prices from the Dutch Healthcare Insurance Board and tariffs provided by the Dutch Healthcare Authority. Linear regression analysis was used to examine the association between hospital costs and various patient and hospital characteristics.


RESULTS
A total of 35,903 ischemic stroke and 21,653 TIA patients were included. Inpatient costs were €5,328 ($6,845) for ischemic stroke and €2,470 ($3,173) for TIA. Outpatient costs were €495 ($636) for ischemic stroke and €587 ($754) for TIA. Costs of carotid endarterectomy were €6,836 ($8,783). Costs of inpatient days were the largest contributor to hospital costs. Age, hospital type, and region were strongly associated with hospital costs.


CONCLUSIONS
Hospital costs are higher for inpatients and ischemic strokes compared with outpatients and TIAs, with length of stay (LOS) the most important contributor. LOS and hospital costs have substantially declined over the last 10 years, possibly due to improved hospital stroke care and efficient integrated stroke services.
From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands. buisman@bmg.eur.nl.
Leander R
LR
Buisman
From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Siok Swan
SS
Tan
From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Paul J
PJ
Nederkoorn
From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Peter J
PJ
Koudstaal
From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
William K
WK
Redekop
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs / Q000639:trends; D006801:Humans; D002546:Ischemic Attack, Transient / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000191:economics* / Q000453:epidemiology* / Q000628:therapy