Modified Rankin scale as a determinant of direct medical costs after stroke.
Background Resource use in the acute and subacute phases after stroke depends on the degree of disability. Aims To determine if direct costs after stroke also vary by level of disability as measured using the modified Rankin scale at the chronic stage after stroke. Methods In a multicentre study, we collected acute and chronic in- and outpatient resource use in survivors of ischemic stroke stratified by levels of disability according to the modified Rankin Scale. Statistical inference on costs at each level of the modified Rankin Scale was estimated using a general linear model for the first three months, the first year, and any subsequent year after ischemic stroke. Results A total of 569 survivors of ischemic stroke with a mean age of 71.7 years were enrolled (41% female) from 10 academic and nonacademic centers. Costs varied substantially over time and with each modified Rankin Scale level. The total average costs in the first year were estimated $33,147 per patient, ranging from $9,114 for modified Rankin Scale 0 to $83,236 for modified Rankin Scale 5. In the second year, medical costs were on average $14,039, varying from $2,921 to $39,723 for patients with modified Rankin Scale 0-5. The level of disability based on the modified Rankin Scale was a major determinant of resource use, irrespective of age, gender, atrial fibrillation, and vascular risk factors. Conclusion Long-term resource use after stroke is high and is mainly driven by degree of disability as measured by the modified Rankin scale.
1 Department of Public Health, Faculty of Medicine, UGent, Belgium.|2 Services in Health Economics, Brussels, Belgium.
Sarah
S
Dewilde
2 Services in Health Economics, Brussels, Belgium.|3 Interuniversity Centre for Health Economics Research UGent, VUB, Belgium.
Lieven
L
Annemans
4 Cliniques Universitaires Saint Luc, Service de Neurologie, Brussels, Belgium.
Andre
A
Peeters
5 Department of Neurology, Ghent University Hospital, Ghent, Belgium.
Dimitri
D
Hemelsoet
6 Neurology Department, Université catholique de Louvain (UcL), Yvoir, Belgium.
Yves
Y
Vandermeeren
7 Centre Hospitalier Chrétien (CHC), Site Saint-Joseph, Liège, Belgium.
Philippe
P
Desfontaines
8 Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.|9 Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Raf
R
Brouns
10 Department of Neurology, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium.
Geert
G
Vanhooren
11 Department of Neurology, Born Bunge Institute, University and University Hospital, Antwerp, Belgium.
Patrick
P
Cras
12 Heilig Hart Ziekenhuis, Lier, Belgium.
Boudewijn
B
Michielsens
13 CHU Ambroise Paré, Mons, Belgium.
Patricia
P
Redondo
14 Austin Health, Department of Neurology and Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Victoria, Australia.
Vincent
V
Thijs
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D002545:Brain Ischemia / Q000150:complications / Q000628:therapy*; D006233:Persons with Disabilities; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000191:economics / Q000628:therapy*; D017741:Survivors
Stroke; cost analysis; costs; modified Rankin Scale