(Stroke. 1996;27:1459-1466.)
© 1996 American Heart Association, Inc.
Articles |
Lifetime Cost of Stroke in the United States
the Program in Pharmaceutical Outcomes and Policy Research, College of Pharmacy (T.N.T., J.W.M.), the Department of Neurology (P.H.D.), the Department of Preventive Medicine and Environmental Health (J.C.T.), and the Department of Social Work (J.H., M.F.J.), University of Iowa (Iowa City).
Correspondence to Thomas N. Taylor, PhD, College of Pharmacy, S518 Pharmacy Bldg, University of Iowa, Iowa City, IA 52242. E-mail ttaylor@blue.weeg.uiowa.edu.
Background and Purpose Stroke imposes a substantial economic burden on individuals and society. This study estimates the lifetime direct and indirect costs associated with the three major types of stroke: subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (ISC).
Methods We developed a model of the lifetime cost of incident strokes occurring in 1990. An epidemiological model of stroke incidence, survival, and recurrence was developed based on a review of the literature. Data on direct cost of treating stroke were obtained from Medicare claims data, the 1987 National Medical Expenditure Survey (NMES), and insurance claims data representing a group of large, self-insured employers. Indirect costs (the value of foregone market and nonmarket production) associated with premature morbidity and mortality were estimated based on data from the US Bureau of Economic Analysis and the 1987 NMES.
Results The lifetime cost per person of first strokes occurring in 1990 is estimated to be $228 030 for SAH, $123 565 for ICH, $90 981 for ISC, and $103 576 averaged across all stroke subtypes. Indirect costs accounted for 58.0% of lifetime costs. Aggregate lifetime cost associated with an estimated 392 344 first strokes in 1990 was $40.6 billion: $5.6 billion for SAH, $6.0 billion for ICH, and $29.0 billion for ISC. Acute-care costs incurred in the 2 years following a first stroke accounted for 45.0%, long-term ambulatory care accounted for 35.0%, and nursing home costs accounted for 17.5% of aggregate lifetime costs of stroke.
Conclusions The lifetime cost of stroke varies considerably by type of stroke and entails considerable costs beyond the first 2 years after a stroke.
Key Words: cost and cost analysis • epidemiology • incidence
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 J. K Freburger An Analysis of the Relationship Between the Utilization of Physical Therapy Services and Outcomes for Patients With Acute Stroke Physical Therapy, October 1, 1999; 79(10): 906 - 918. [Abstract] [Full Text] [PDF]
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A. Mamoli, B. Censori, L. Casto, C. Sileo, B. Cesana, and M. Camerlingo An analysis of the costs of ischemic stroke in an Italian stroke unit Neurology, July 1, 1999; 53(1): 112 - 112. [Abstract] [Full Text] [PDF]
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R. G. Holloway, C. G. Benesch, C. R. Rahilly, and C. E. Courtright A Systematic Review of Cost-Effectiveness Research of Stroke Evaluation and Treatment Stroke, July 1, 1999; 30(7): 1340 - 1349. [Abstract] [Full Text] [PDF]
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R. D. Brown Jr, J. Ransom, S. Hass, G. W. Petty, W. M. O'Fallon, J. P. Whisnant, and C. L. Leibson Use of Nursing Home After Stroke and Dependence on Stroke Severity : A Population-Based Analysis Stroke, May 1, 1999; 30(5): 924 - 929. [Abstract] [Full Text] [PDF]
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P. M. Meyers, G. A. Thakur, and T. A. Tomsick Temporary Endovascular Balloon Occlusion of the Internal Carotid Artery with a Nondetachable Silicone Balloon Catheter: Analysis of Technique and Cost AJNR Am. J. Neuroradiol., April 1, 1999; 20(4): 559 - 564. [Abstract] [Full Text]
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P. B. Gorelick, R. L. Sacco, D. B. Smith, M. Alberts, L. Mustone-Alexander, D. Rader, J. L. Ross, E. Raps, M. N. Ozer, L. M. Brass, et al. Prevention of a First Stroke: A Review of Guidelines and a Multidisciplinary Consensus Statement From the National Stroke Association JAMA, March 24, 1999; 281(12): 1112 - 1120. [Abstract] [Full Text] [PDF]
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S. R. Levine and M. Gorman "Telestroke" : The Application of Telemedicine for Stroke Stroke, February 1, 1999; 30(2): 464 - 469. [Abstract] [Full Text] [PDF]
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C. Y. Tung, C. B. Granger, M. A. Sloan, E. J. Topol, J. D. Knight, W. D. Weaver, K. W. Mahaffey, H. White, N. Clapp-Channing, M. L. Simoons, et al. Effects of Stroke on Medical Resource Use and Costs in Acute Myocardial Infarction Circulation, January 26, 1999; 99(3): 370 - 376. [Abstract] [Full Text] [PDF]
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H. Ellekjær, J. Holmen, O. Kruger, and A. Terent Identification of Incident Stroke in Norway : Hospital Discharge Data Compared With a Population-Based Stroke Register Stroke, January 1, 1999; 30(1): 56 - 60. [Abstract] [Full Text] [PDF]
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C. Tran, Z. Nadareishvili, L. Smurawska, P. I.T. Oh, and J. W. Norris Decreasing Costs of Stroke Hospitalization in Toronto Stroke, January 1, 1999; 30 (1): 185 - 186. [Full Text] [PDF]
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M. J. Alberts, S. Chaturvedi, G. Graham, R. L. Hughes, D. G. Jamieson, F. Krakowski, E. Raps, and P. Scott Acute Stroke Teams : Results of a National Survey Stroke, November 1, 1998; 29(11): 2318 - 2320. [Abstract] [Full Text] [PDF]
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T. A. Jacobson, J. R. Schein, A. Williamson, and C. M. Ballantyne Maximizing the Cost-effectiveness of Lipid-Lowering Therapy Arch Intern Med, October 12, 1998; 158(18): 1977 - 1989. [Abstract] [Full Text] [PDF]
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 K. Whetten-Goldstein, F. A Sloan, L. B Goldstein, and E. D Kulas A comprehensive assessment of the cost of multiple sclerosis in the United States Multiple Sclerosis, October 1, 1998; 4(5): 419 - 425. [Abstract] [PDF]
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S. Lightowlers and A. McGuire Cost-Effectiveness of Anticoagulation in Nonrheumatic Atrial Fibrillation in the Primary Prevention of Ischemic Stroke Stroke, September 1, 1998; 29(9): 1827 - 1832. [Abstract] [Full Text] [PDF]
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J. G. Frazee, X. Luo, G. Luan, D. S. Hinton, D. A. Hovda, M. S. Shiroishi, L. T. Barcliff, and H. A. Kontos Retrograde Transvenous Neuroperfusion: A Back Door Treatment for Stroke • Editorial Comment Stroke, September 1, 1998; 29(9): 1912 - 1916. [Abstract] [Full Text] [PDF]
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C. L. Leibson, J. E. Ransom, R. D. Brown, W. M. O'Fallon, S. L. Hass, and J. P. Whisnant Stroke-attributable nursing home use: A population-based study Neurology, July 1, 1998; 51(1): 163 - 168. [Abstract] [Full Text] [PDF]
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P. B. Fontanarosa and M. A. Winker Timely and Appropriate Treatment of Acute Stroke: What's Missing From This Picture? JAMA, April 22, 1998; 279(16): 1307 - 1309. [Full Text] [PDF]
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 J. Lipscomb, M. Ancukiewicz, G. Parmigiani, V. Hasselblad, G. Samsa, and D. B. Matchar Predicting the Cost of Illness: A Comparison of Alternative Models Applied to Stroke Med Decis Making, April 1, 1998; 18(2): S39 - S56. [Abstract] [PDF]
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 H. P. Adams Jr Treating Ischemic Stroke as an Emergency Arch Neurol, April 1, 1998; 55(4): 457 - 461. [Abstract] [Full Text] [PDF]
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T. A. Hodgson, J. F. Fries, D. Heaney, B. N. Leistikow, T. R. Miller, C. Sauter, J. J. Barendregt, L. Bonneux, and P. J. van der Maas The Health Care Costs of Smoking N. Engl. J. Med., February 12, 1998; 338(7): 470 - 472. [Full Text]
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R. X. You, J. J. McNeil, H. M. O'Malley, S. M. Davis, A. G. Thrift, and G. A. Donnan Risk Factors for Stroke Due to Cerebral Infarction in Young Adults Stroke, October 1, 1997; 28(10): 1913 - 1918. [Abstract] [Full Text]
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J. M. Lightwood and S. A. Glantz Short-term Economic and Health Benefits of Smoking Cessation : Myocardial Infarction and Stroke Circulation, August 19, 1997; 96(4): 1089 - 1096. [Abstract] [Full Text]
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 T. Brott Thrombolysis for Stroke Arch Fam Med, March 1, 1997; 6(2): 101 - 102. [Abstract] [PDF]
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T. Brott Thrombolysis for Stroke Arch Neurol, December 1, 1996; 53(12): 1305 - 1306. [Abstract] [PDF]
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