Duy Le, MD
Previous attempts have been made to evaluate the economic burden of ischemic stroke. The NEMESIS study, an Australian based study, evaluated costs 3 to 5 years out from the original stroke event. Gloede et al push the envelope by attempting to quantify the cost of ischemic stroke (IS) and intracranial hemorrhage (ICH) 10 years out. They used The Model of Resource Utilization Costs and Outcomes for Stroke (MORUCS) which was also employed by the NEMESIS study. NEMESIS patients were evaluated in this study and followed out to 10 years. The cost of illness models for both IS and ICH were updated from a 2004 to 2010 reference year, adjusting for inflation. The Australian population was used in this model and currency translated to USD in terms of cost.
For first ever IS, 243/283 of the NEMESIS participants were interviewed (86% responder rate). For first ever ICH, 43/50 of the NEMESIS participants were interviewed. For IS, the overall average annual direct cost at 10 years was similar to survivors between 3-5 years (5,207 USD). The distribution of the costs however varied, as medication increased from 13% to 20%, while cost for rehabilitation services and facilities decreased over that same time span. ICH on the other hand had an increase of 24% in annual direct costs (from 5,807 USD to 7,607). Aged-care facility-costs for ICH were noted to be 64% higher at 10 years compared to 3-5 years. Costs were highest within the first year for both IS and ICH. Although the most practical way to evaluate the question of long term cost is to employ surveys as this study did; this is also the study’s biggest limitation. Surveys inherently can be biased, depending on the responder. Additionally, an Australian population was analyzed in an attempt to extrapolate costs for US patients.
From this study, we find out that the cost of a first time ischemic stroke goes beyond the initial costs up front. The annual cost 10 years post IS however are not different from 3-5 years post IS. While some may argue this does not offer much information to us, it still reaffirms the fact that the financial burden of stroke is felt long after in the initial event. On the other end, ICH costs increase annually at 10 years compared to 3-5 years due to increased care facility costs; further making the point that the financial burden of these disease processes continue long after the index event. Patient, families and physicians should be aware of this when dealing with patients in both the inpatient and outpatient setting with these disease processes.
This probably could be vastly reduced if we had some translational work done on existing research that stops the neuronal cascade of death. Less dead and dying neurons would directly lead to less disability. For my next stroke I will be demanding at least 31 interventions from my doctors in the first week. Starting with statins, leg compressions, fish oil,anti-depressants, music, Ibuprofen, melatonin, etc., etc., etc.