title: Direct medical cost of stroke in Singapore.
abstract: BACKGROUND
  Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure.
  
  
  OBJECTIVE
  To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors.
  
  
  METHODS
  The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications.
  
  
  RESULTS
  A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P < 0·001) and intracerebral haemorrhage (P < 0·001), shorter poststroke period, more than one complications (P = 0·045), and a greater number of comorbidities (P = 0·001).
  
  
  CONCLUSIONS
  There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.
authors.forename: Charmaine Shuyu
authors.identifier: http://orcid.org/0000-0001-9594-1214
authors.initials: CS
authors.lastname: Ng
authors.affiliation: Information Management, Central Regional Health Office, National Healthcare Group, Singapore, Singapore.|Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
authors.forename: Matthias Paul Han Sim
authors.initials: MP
authors.lastname: Toh
authors.affiliation: Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.
authors.forename: Jiaying
authors.initials: J
authors.lastname: Ng
authors.affiliation: School of Pharmacy, College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ko
mesh_terms: D000368:Aged; D017281:Cost of Illness; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D020521:Stroke / Q000191:economics / Q000453:epidemiology / Q000628:therapy
keywords: cost analysis; cost of disease; cost-of-illness; economic burden; healthcare costs; stroke