Skip to main content
Erschienen in: The European Journal of Health Economics 4/2017

15.04.2016 | Original Paper

Economic impact of patients admitted to stroke units in Spain

verfasst von: Jose Alvarez-Sabín, Manuel Quintana, Jaime Masjuan, Juan Oliva-Moreno, Javier Mar, Nuria Gonzalez-Rojas, Virginia Becerra, Covadonga Torres, María Yebenes, CONOCES Investigators Group

Erschienen in: The European Journal of Health Economics | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Abstract

Objectives

Stroke is a major social and health problem. However, since the recent incorporation of new advances in its management, little is known about the cost of stroke. The aim of this study is to find out the real cost of stroke in Spain.

Methods

This is an epidemiological, observational, prospective, multicenter study of patients diagnosed with stroke and admitted to a stroke unit. Patients were recruited from 16 hospitals throughout Spain and followed up for 1 year. Sociodemographic, clinical, and economic data were collected. Costs (€ 2012) were estimated from the social perspective and were divided into direct healthcare (inpatient, outpatient, and medication), direct non-healthcare (mainly formal and informal care) and labor productivity losses.

Results

A total of 321 patients were included. Mean age was 72.1 years and 176 patients (54.8 %) were male. Total average cost per patient/year was €27,711. Direct healthcare costs amounted to €8491 per patient/year (68.8 % due to inpatient costs) and non-healthcare costs to an average of €18,643 per patient/year (89.5 % due to informal care). Productivity loss costs per patient/year were €276. Total costs of hemorrhagic strokes were slightly higher than ischemic (€28,895 vs. €27,569 per patient/year, p = 0.550) without significant differences. The main variables associated with higher costs were the presence of hypertension (€30,332 vs. €23,234 per patient/year, p < 0.05) and the severity of stroke (p < 0.05), both independently associated after a multivariate analysis.

Conclusions

The cost of patients admitted to stroke units in Spain is €27,711 per patient/year. More than two-thirds are social costs, mainly informal care. Stroke remains a major burden on health systems and society, so additional efforts are needed for its prevention.
Literatur
1.
Zurück zum Zitat Lackland, D.T., Roccella, E.J., Deutsch, A.F., Fornage, M., George, M.G., Howard, G., Kissela, B.M., Kittner, S.J., Lichtman, J.H., Lisabeth, L.D., Schwamm, L.H., Smith, E.E., Towfighi, A.: Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 45, 315–353 (2014)CrossRefPubMed Lackland, D.T., Roccella, E.J., Deutsch, A.F., Fornage, M., George, M.G., Howard, G., Kissela, B.M., Kittner, S.J., Lichtman, J.H., Lisabeth, L.D., Schwamm, L.H., Smith, E.E., Towfighi, A.: Factors influencing the decline in stroke mortality: a statement from the American Heart Association/American Stroke Association. Stroke 45, 315–353 (2014)CrossRefPubMed
2.
Zurück zum Zitat Nichols-Larsen, D.S., Clark, P.C., Zeringue, A., Greenspan, A., Blanton, S.: Factors influencing stroke survivor’s quality of life during subacute recovery. Stroke 36, 1480–1484 (2005)CrossRefPubMed Nichols-Larsen, D.S., Clark, P.C., Zeringue, A., Greenspan, A., Blanton, S.: Factors influencing stroke survivor’s quality of life during subacute recovery. Stroke 36, 1480–1484 (2005)CrossRefPubMed
3.
Zurück zum Zitat Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Borden, W.B., Bravata, D.M., Dai, S., Ford, E.S., Fox, C.S., Franco, S., Fullerton, H.J., Gillespie, C., Hailpern, S.M., Heit, J.A., Howard, V.J., Huffman, M.D., Kissela, B.M., Kittner, S.J., Lackland, D.T., Lichtman, J.H., Lisabeth, L.D., Magid, D., Marcus, G.M., Marelli, A., Matchar, D.B., McGuire, D.K., Mohler, E.R., Moy, C.S., Mussolino, M.E., Nichol, G., Paynter, N.P., Schreiner, P.J., Sorlie, P.D., Stein, J., Turan, T.N., Virani, S.S., Wong, N.D., Woo, D., Turner, M.B.: Heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation 127, e6–e245 (2013)CrossRefPubMed Go, A.S., Mozaffarian, D., Roger, V.L., Benjamin, E.J., Berry, J.D., Borden, W.B., Bravata, D.M., Dai, S., Ford, E.S., Fox, C.S., Franco, S., Fullerton, H.J., Gillespie, C., Hailpern, S.M., Heit, J.A., Howard, V.J., Huffman, M.D., Kissela, B.M., Kittner, S.J., Lackland, D.T., Lichtman, J.H., Lisabeth, L.D., Magid, D., Marcus, G.M., Marelli, A., Matchar, D.B., McGuire, D.K., Mohler, E.R., Moy, C.S., Mussolino, M.E., Nichol, G., Paynter, N.P., Schreiner, P.J., Sorlie, P.D., Stein, J., Turan, T.N., Virani, S.S., Wong, N.D., Woo, D., Turner, M.B.: Heart disease and stroke statistics-2013 update: a report from the American Heart Association. Circulation 127, e6–e245 (2013)CrossRefPubMed
4.
Zurück zum Zitat Seenan, P., Long, M., Langhorne, P.: Stroke units in their natural habitat: systematic review of observational studies. Stroke 38, 1886–1892 (2007)CrossRefPubMed Seenan, P., Long, M., Langhorne, P.: Stroke units in their natural habitat: systematic review of observational studies. Stroke 38, 1886–1892 (2007)CrossRefPubMed
5.
Zurück zum Zitat Candelise, L., Gattinoni, M., Bersano, A., Micieli, G., Sterzi, R., Morabito, A.: Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 369, 299–305 (2007)CrossRefPubMed Candelise, L., Gattinoni, M., Bersano, A., Micieli, G., Sterzi, R., Morabito, A.: Stroke-unit care for acute stroke patients: an observational follow-up study. Lancet 369, 299–305 (2007)CrossRefPubMed
6.
Zurück zum Zitat Lees, K.R., Bluhmki, E., Von Kummer, R., Brott, T.G., Toni, D., Grotta, J.C., Albers, G.W., Kaste, M., Marler, J.R., Hamilton, S.A., Tilley, B.C., Davis, S.M., Donnan, G.A., Hacke, W.: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375, 1695–1703 (2010)CrossRefPubMed Lees, K.R., Bluhmki, E., Von Kummer, R., Brott, T.G., Toni, D., Grotta, J.C., Albers, G.W., Kaste, M., Marler, J.R., Hamilton, S.A., Tilley, B.C., Davis, S.M., Donnan, G.A., Hacke, W.: Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 375, 1695–1703 (2010)CrossRefPubMed
7.
Zurück zum Zitat Mar, J., Masjuan, J., Oliva-Moreno, J., Gonzalez-Rojas, N., Becerra, V., Casado, M.A., Torres, C., Yebenes, M., Quintana, M., Alvarez-Sabín, J.: CONOCES Investigators Group: outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain. Health Qual Life Outcomes 13, 230 (2015)CrossRef Mar, J., Masjuan, J., Oliva-Moreno, J., Gonzalez-Rojas, N., Becerra, V., Casado, M.A., Torres, C., Yebenes, M., Quintana, M., Alvarez-Sabín, J.: CONOCES Investigators Group: outcomes measured by mortality rates, quality of life and degree of autonomy in the first year in stroke units in Spain. Health Qual Life Outcomes 13, 230 (2015)CrossRef
8.
Zurück zum Zitat Plan de atención sanitaria al ictus, Alvarez Sabín, j, Alonso De Leciñana, M., Gállego, J., Gil-Peralta, A., Castillo, J., Díez Tejedor, E., Jiménez, C., Gil, A., Lago, C., Martínez-Vila, E., Ortega, A., Rebollo, M., Rubio, F.: Plan de atención sanitaria al ictus. Neurología 21, 717–726 (2006) Plan de atención sanitaria al ictus, Alvarez Sabín, j, Alonso De Leciñana, M., Gállego, J., Gil-Peralta, A., Castillo, J., Díez Tejedor, E., Jiménez, C., Gil, A., Lago, C., Martínez-Vila, E., Ortega, A., Rebollo, M., Rubio, F.: Plan de atención sanitaria al ictus. Neurología 21, 717–726 (2006)
9.
Zurück zum Zitat Masjuan, J., Alvarez-Sabín, J., Arenillas, J., Calleja, S., Castillo, J., Dávalo, A., Díez Tejedor, E., Freijo, M., Gil-Núñez, A., Fernández, J.C., Maestre, J.F., Martínez-Vila, E., Morales, A., Purroy, F., Ramírez, J.M., Segura, T., Serena, J., Tejada, J., Tejero, C.: Plan de asistencia sanitaria al ICTUS II. 2010. Neurología 26, 383–396 (2011) Masjuan, J., Alvarez-Sabín, J., Arenillas, J., Calleja, S., Castillo, J., Dávalo, A., Díez Tejedor, E., Freijo, M., Gil-Núñez, A., Fernández, J.C., Maestre, J.F., Martínez-Vila, E., Morales, A., Purroy, F., Ramírez, J.M., Segura, T., Serena, J., Tejada, J., Tejero, C.: Plan de asistencia sanitaria al ICTUS II. 2010. Neurología 26, 383–396 (2011)
11.
Zurück zum Zitat Carod-Artal, F.J., Egido-Navarro, J.A., González-Gutiérrez, J.L.: Varela De Seijas, E.: direct cost of cerebrovascular disease during the first year of follow-up. Rev. Neurol. 28, 1123–1130 (1999)PubMed Carod-Artal, F.J., Egido-Navarro, J.A., González-Gutiérrez, J.L.: Varela De Seijas, E.: direct cost of cerebrovascular disease during the first year of follow-up. Rev. Neurol. 28, 1123–1130 (1999)PubMed
12.
Zurück zum Zitat Spieler, J.F., Lanoë, J.L., Amarenco, P.: Costs of stroke care according to handicap levels and stroke subtypes. Cerebrovasc. Dis. 17, 134–142 (2004)CrossRefPubMed Spieler, J.F., Lanoë, J.L., Amarenco, P.: Costs of stroke care according to handicap levels and stroke subtypes. Cerebrovasc. Dis. 17, 134–142 (2004)CrossRefPubMed
13.
Zurück zum Zitat Beguiristain, J.M., Mar, J.: Arrazola, A: coste de la enfermedad cerebrovascular aguda. Rev. Neurol. 40, 406–411 (2005)PubMed Beguiristain, J.M., Mar, J.: Arrazola, A: coste de la enfermedad cerebrovascular aguda. Rev. Neurol. 40, 406–411 (2005)PubMed
14.
Zurück zum Zitat Hervás-Angulo, A., Cabasés-Hita, J.M., Forcén-Alonso, T.: Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at 3 years. Rev. Neurol. 43, 518–525 (2006)PubMed Hervás-Angulo, A., Cabasés-Hita, J.M., Forcén-Alonso, T.: Costs deriving from strokes from a social perspective. A retrospective incidence approach with a follow-up at 3 years. Rev. Neurol. 43, 518–525 (2006)PubMed
15.
Zurück zum Zitat Navarrete-Navarro, P., Hart, W.M., López-Bastida, J., Christensen, M.C.: The societal costs of intracerebral hemorrhage in Spain. Eur. J. Neurol. 14, 556–562 (2007)CrossRefPubMed Navarrete-Navarro, P., Hart, W.M., López-Bastida, J., Christensen, M.C.: The societal costs of intracerebral hemorrhage in Spain. Eur. J. Neurol. 14, 556–562 (2007)CrossRefPubMed
16.
Zurück zum Zitat López-Bastida, J.: Oliva Moreno, J., Worbes Cerezo, M., Perestelo Pérez, L., Serrano-Aguilar, P., Montón-Álvarez, F.: social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain. BMC Health Serv. Res. 12, 315 (2012)CrossRefPubMedPubMedCentral López-Bastida, J.: Oliva Moreno, J., Worbes Cerezo, M., Perestelo Pérez, L., Serrano-Aguilar, P., Montón-Álvarez, F.: social and economic costs and health-related quality of life in stroke survivors in the Canary Islands, Spain. BMC Health Serv. Res. 12, 315 (2012)CrossRefPubMedPubMedCentral
17.
Zurück zum Zitat Fattore, G., Torbica, A., Susi, A., Giovanni, A., Benelli, G., Gozzo, M., Toso, V.: The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 12, 137 (2012)CrossRefPubMedPubMedCentral Fattore, G., Torbica, A., Susi, A., Giovanni, A., Benelli, G., Gozzo, M., Toso, V.: The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 12, 137 (2012)CrossRefPubMedPubMedCentral
18.
19.
Zurück zum Zitat Luengo-Fernández, R., Gray, A.M., Rothwell, P.M.: A population-based study of hospital care costs during 5 years after transient ischemic attack and stroke. Stroke 43, 3343–3351 (2012)CrossRefPubMedPubMedCentral Luengo-Fernández, R., Gray, A.M., Rothwell, P.M.: A population-based study of hospital care costs during 5 years after transient ischemic attack and stroke. Stroke 43, 3343–3351 (2012)CrossRefPubMedPubMedCentral
20.
Zurück zum Zitat Mar, J., Alvarez-Sabín, J., Oliva, J., Becerra, V., Casado, M.A., Yébenes, M., González-Rojas, N., Arenillas, J.F., Martínez-Zabaleta, M.T., Rebollo, M., Lago, A., Segura, T., Castillo, J., Gállego, J., Jiménez-Martínez, C., López-Gastón, J.I., Moniche, F., Casado-Naranjo, I., López-Fernández, J.C., González-Rodríguez, C., Escribano, B., Masjuan, J.: Los costes del ictus en España según su etiología. El protocolo del estudio CONOCES. Neurologia 28, 332–339 (2013) Mar, J., Alvarez-Sabín, J., Oliva, J., Becerra, V., Casado, M.A., Yébenes, M., González-Rojas, N., Arenillas, J.F., Martínez-Zabaleta, M.T., Rebollo, M., Lago, A., Segura, T., Castillo, J., Gállego, J., Jiménez-Martínez, C., López-Gastón, J.I., Moniche, F., Casado-Naranjo, I., López-Fernández, J.C., González-Rodríguez, C., Escribano, B., Masjuan, J.: Los costes del ictus en España según su etiología. El protocolo del estudio CONOCES. Neurologia 28, 332–339 (2013)
25.
Zurück zum Zitat Catálogo General de Material Ortoprotésico. Boletín Oficial del País Vasco - lunes 30 de julio de 2007. http://www.lehendakaritza.ejgv. euskadi.net/r48-vacia/es/bopv2/datos/2007/07/0704289a.pdf. (2007). Accessed 21 November 2015 Catálogo General de Material Ortoprotésico. Boletín Oficial del País Vasco - lunes 30 de julio de 2007. http://​www.​lehendakaritza.​ejgv. euskadi.net/r48-vacia/es/bopv2/datos/2007/07/0704289a.pdf. (2007). Accessed 21 November 2015
28.
Zurück zum Zitat Van Den Berg, B., Brouwer, W.B.F., Koopmanschap, M.A.: Economic valuation of informal care. An overview of methods and applications. Eur. J. Health Econ. 5, 36–45 (2004)CrossRefPubMed Van Den Berg, B., Brouwer, W.B.F., Koopmanschap, M.A.: Economic valuation of informal care. An overview of methods and applications. Eur. J. Health Econ. 5, 36–45 (2004)CrossRefPubMed
30.
Zurück zum Zitat Grossman, M.: The demand for health: a theoretical and empirical investigation. Columbia University Press, Oxford (1972) Grossman, M.: The demand for health: a theoretical and empirical investigation. Columbia University Press, Oxford (1972)
31.
Zurück zum Zitat Diringer, M.N., Edwards, D.F., Mattson, D.T., Atkins, P.T., Sheedy, C.W., Hsu, C.Y., Dromerick, A.W.: Predictors of acute hospital costs for treatment of ischemic stroke in an academic center. Stroke 30, 724–728 (1999)CrossRefPubMed Diringer, M.N., Edwards, D.F., Mattson, D.T., Atkins, P.T., Sheedy, C.W., Hsu, C.Y., Dromerick, A.W.: Predictors of acute hospital costs for treatment of ischemic stroke in an academic center. Stroke 30, 724–728 (1999)CrossRefPubMed
32.
Zurück zum Zitat Félix-Redondo, F.J., Consuegra-Sánchez, L., Ramírez-Moreno, J.M., Lozano, L., Escudero, V., Fernández-Bergés, D.: Tendencia de la mortalidad por ictus isquémico (2000-2009) y factores pronóstico. Estudio ICTUS-Extremadura. Rev. Clín. Española 213, 177–185 (2013)CrossRef Félix-Redondo, F.J., Consuegra-Sánchez, L., Ramírez-Moreno, J.M., Lozano, L., Escudero, V., Fernández-Bergés, D.: Tendencia de la mortalidad por ictus isquémico (2000-2009) y factores pronóstico. Estudio ICTUS-Extremadura. Rev. Clín. Española 213, 177–185 (2013)CrossRef
33.
Zurück zum Zitat Comas-Herrera, A., Wittenberg, R., Costa-Font, J., Gori, C., Di Maio, A., Patxot, C., Pickard, L., Pozzi, A., Rothgang, H.: Future long-term care expenditure in Germany, Spain, Italy and the United Kingdom. Ageing and society 26, 285–302 (2006)CrossRef Comas-Herrera, A., Wittenberg, R., Costa-Font, J., Gori, C., Di Maio, A., Patxot, C., Pickard, L., Pozzi, A., Rothgang, H.: Future long-term care expenditure in Germany, Spain, Italy and the United Kingdom. Ageing and society 26, 285–302 (2006)CrossRef
34.
Zurück zum Zitat Economic Policy Committee (2009) European Economy No. 2/2009. 2009 Ageing Report: Economic and budgetary projections for the EU-27 Member States (2008–2060) Economic Policy Committee (2009) European Economy No. 2/2009. 2009 Ageing Report: Economic and budgetary projections for the EU-27 Member States (2008–2060)
36.
Zurück zum Zitat Castillo, J., Vivancos-Mora, J.: Tiempos de llegada al hospital y hasta la atención neurológica de pacientes con ictus agudo. Análisis de un registro multicéntrico nacional: registro EPICES (II). Rev. Neurol. 54, 461–467 (2012)PubMed Castillo, J., Vivancos-Mora, J.: Tiempos de llegada al hospital y hasta la atención neurológica de pacientes con ictus agudo. Análisis de un registro multicéntrico nacional: registro EPICES (II). Rev. Neurol. 54, 461–467 (2012)PubMed
Metadaten
Titel
Economic impact of patients admitted to stroke units in Spain
verfasst von
Jose Alvarez-Sabín
Manuel Quintana
Jaime Masjuan
Juan Oliva-Moreno
Javier Mar
Nuria Gonzalez-Rojas
Virginia Becerra
Covadonga Torres
María Yebenes
CONOCES Investigators Group
Publikationsdatum
15.04.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
The European Journal of Health Economics / Ausgabe 4/2017
Print ISSN: 1618-7598
Elektronische ISSN: 1618-7601
DOI
https://doi.org/10.1007/s10198-016-0799-9

Weitere Artikel der Ausgabe 4/2017

The European Journal of Health Economics 4/2017 Zur Ausgabe