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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

The cost of first-ever stroke in Valle d’Aosta, Italy: linking clinical registries and administrative data

BMC Health Services Research > Ausgabe 1/2012
Edo Bottacchi, Giovanni Corso, Piera Tosi, Massimo Veronese Morosini, Giuseppe De Filippis, Laura Santoni, Gianluca Furneri, Cristina Negrini
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-372) contains supplementary material, which is available to authorized users.

Competing interests

The study was sponsored by Pfizer Italy. Simon-Kucher and Partners received grant from Pfizer Italy to participate in the study, contribute to the analysis and draft the manuscript. EB, GC, PT, MVM, GDF declare they have no competing interests and have not received grants or funding to participate in the study. At the time of study conduction, GF was a full-time employee of Simon-Kucher and Partners and received a salary from Simon-Kucher and Partners. GF was previously a full employee of Pfizer Italy (May 2004-October 2008). At the time of study conduction, LS was a full-time employee of Pfizer Italy and received a salary from Pfizer Italy. CN is a full-time employee of Simon-Kucher and Partners and receives a salary from Simon-Kucher and Partners.

Authors’ contributions

EB, GC, PT, LS, GF and CN participated in the study design and approved the final version of the present article. MVM managed data extraction, data cleaning and record linkage of the different databases used in the analysis. MVM and GF performed statistical analysis. EB, GC, PT, LS and CN supervised statistical analysis. All authors contributed to interpretation of analysis results. EB, GC, PT and GF wrote the manuscript for scientific publication. LS, GDF, CN reviewed the final content of the manuscript. EB, GC, LS and GF coordinated the overall analysis project. All authors read and approved the final manuscript.



Stroke is one of the most relevant reasons of death and disability worldwide. Many cost of illness studies have been performed to evaluate direct and indirect costs of ischaemic stroke, especially within the first year after the acute episode, using different methodologies.


We conducted a longitudinal, retrospective, bottom-up cost of illness study, to evaluate clinical and economic outcomes of a cohort of patients affected by a first cerebrovascular event, including subjects with ischaemic, haemorrhagic or transient episodes. The analysis intended to detect direct costs, within 1, 2 and 3 years from the index event. Clinical patient data collected in regional disease registry were integrated and linked to regional administrative databases to perform the analysis.


The analysis of costs within the first year from the index event included 800 patients. The majority of patients (71.5%) were affected by ischaemic stroke. Overall, per patient costs were €7,079. Overall costs significantly differ according to the type of stroke, with costs for haemorrhagic stroke and ischaemic stroke amounting to €9,044 and €7,289. Hospital costs, including inpatient rehabilitation, were driver of expenditure, accounting for 89.5% of total costs. The multiple regression model showed that sex, level of physical disability and level of neurological deficit predict direct healthcare costs within 1 year. The analysis at 2 and 3 years (per patient costs: €7,901 and €8,874, respectively) showed that majority of costs are concentrated in the first months after the acute event.


This cost analysis highlights the importance to set up significant prevention programs to reduce the economic burden of stroke, which is mostly attributable to hospital and inpatient rehabilitation costs immediately after the acute episode. Although some limitation typical of retrospective analyses the approach of linking clinical and administrative database is a power tool to obtain useful information for healthcare planning.
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