International Comparison of Poststroke Resource Use: A Longitudinal Analysis in Europe.
BACKGROUND
Long-term costs often represent a large proportion of the total costs induced by stroke, but data on long-term poststroke resource use are sparse, especially regarding the trajectory of costs by severity. We used a multinational longitudinal survey to estimate patterns of poststroke resource use by degree of functional disability and to compare resource use between regions.


METHODS
The Survey of Health, Ageing and Retirement in Europe (SHARE) is a multinational database of adults 50 years and older, which includes demographic information about respondents, age when stroke first occurred, current activity of daily living (ADL) limitations, and health care resource use in the year before interview. We modeled resource use with a 2-part regression for number of hospital days, home nursing hours, and paid and unpaid home caregiving hours.


RESULTS
After accounting for time since stroke, number of strokes and comorbidities, age, gender, and European regions, we found that poststroke resource use was strongly associated with ADL limitations. The duration since the stroke event was significantly associated only with inpatient care, and informal help showed significant regional heterogeneity across all ADL limitation levels.


CONCLUSIONS
Poststroke physical deficits appear to be a strong driver of long-term resource utilization; treatments that decrease such deficits offer substantial potential for downline cost savings. Analyzing internationally comparable panel data, such as SHARE, provide valuable insight into long-term cost of stroke. More comprehensive international comparisons will require registries with follow-up, particularly for informal and formal home-based care.
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore; Department of Internal Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina. Electronic address: david.matchar@duke-nus.edu.sg.
David B
DB
Matchar
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
Marcel
M
Bilger
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea; Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
Young K
YK
Do
Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore.
Kirsten
K
Eom
D000368:Aged; D000369:Aged, 80 and over; D005060:Europe / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012044:Regression Analysis; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*
2-part model; Poststroke resource utilization; SHARE; long-term care services; regional heterogeneity; stroke registry