(Stroke. 1997;28:1138-1141.)
© 1997 American Heart Association, Inc.
Articles |
Acute Stroke Care and Rehabilitation: An Analysis of the Direct Cost and Its Clinical and Social Determinants
The Copenhagen Stroke Study
From the Departments of Neurology (H.S.J., H.N., T.S.O.) and Radiology (H.O.R.), Bispebjerg Hospital, Copenhagen, Denmark.
Correspondence to Henrik Stig Jørgensen, MD, Department of Neurology, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark.
Background and Purpose Stroke represents a major economic challenge to society. The direct cost of stroke is largely determined by the duration of hospital stay, but internationally applicable estimates of the direct cost of acute stroke care and rehabilitation on cost-efficient stroke units are not available. Information regarding social and medical factors influencing the length of hospital stay (LOHS) and thereby cost is needed to direct cost-reducing efforts.
Methods We determined the direct cost of stroke in the prospective, consecutive, and community-based stroke population of the Copenhagen Stroke Study by measuring the total LOHS in the 1197 acute stroke patients included in the study. All patients had all their acute care and rehabilitation on a dedicated stroke unit. Neurological impairment was measured by the Scandinavian Stroke Scale. Local nonmedical factors affecting the LOHS, such as waiting time for discharge to a nursing home after completed rehabilitation, were accounted for in the analysis. The influence of social and medical factors on the LOHS was analyzed in a multiple linear regression model.
Results The average LOHS was 27.1 days (SD, 44.1; range, 1 to 193), corresponding to a direct cost of $12.150 per patient including all acute care and rehabilitation. The LOHS increased with increasing stroke severity (6 days per 10-point increase in severity; P<.0001) and single marital status (3.4 days; P=.02). Death reduced LOHS (22.0 days; P<.0001). Age, sex, diabetes, hypertension, claudication, ischemic heart disease, atrial fibrillation, former stroke, other disabling comorbidity, smoking, daily alcohol consumption, and the type of stroke (hemorrhage/infarct) had no independent influence on LOHS.
Conclusions Acute care and rehabilitation of unselected patients on a dedicated stroke unit takes on average 4 weeks. In general, comorbidity such as diabetes or heart disease does not increase LOHS. Efforts to reduce costs should therefore aim at reducing initial stroke severity or improving the rate of recovery.
Key Words: costs and cost analysis • risk factors • stroke, acute • stroke units
This article has been cited by other articles:
 |
|
 |
|
  J. Nuyen, P. M. Spreeuwenberg, P. P. Groenewegen, G. A.M. van den Bos, and F. G. Schellevis Impact of Preexisting Depression on Length of Stay and Discharge Destination Among Patients Hospitalized for Acute Stroke: Linked Register-Based Study Stroke, January 1, 2008; 39(1): 132 - 138. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. D. Schleinitz and P. A. Heidenreich A Cost-Effectiveness Analysis of Combination Antiplatelet Therapy for High-Risk Acute Coronary Syndromes: Clopidogrel plus Aspirin versus Aspirin Alone Ann Intern Med, February 15, 2005; 142(4): 251 - 259. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Yoneda, T. Uehara, H. Yamasaki, Y. Kita, M. Tabuchi, and E. Mori Hospital-Based Study of the Care and Cost of Acute Ischemic Stroke in Japan Stroke, March 1, 2003; 34(3): 718 - 724. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-C. Chang, M.-C. Tseng, H.-H. Weng, Y.-H. Lin, C.-W. Liou, and T.-Y. Tan Prediction of Length of Stay of First-Ever Ischemic Stroke Stroke, November 1, 2002; 33(11): 2670 - 2674. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. D. Reed, D. K. Blough, K. Meyer, and J. G. Jarvik Inpatient costs, length of stay, and mortality for cerebrovascular events in community hospitals Neurology, July 24, 2001; 57(2): 305 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Caro, K. F. Huybrechts, and H. E. Kelley Predicting Treatment Costs After Acute Ischemic Stroke on the Basis of Patient Characteristics at Presentation and Early Dysfunction Stroke, January 1, 2001; 32(1): 100 - 106. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S J McNulty, D Hutchinson, and K J Hardy Implementation of antithrombotic management in atrial fibrillation Postgrad. Med. J., December 1, 2000; 76(902): 783 - 786. [Abstract] [Full Text]
|
|
|
|
|
|
L. Claesson, G. Gosman-Hedstrom, M. Johannesson, B. Fagerberg, and C. Blomstrand Resource Utilization and Costs of Stroke Unit Care Integrated in a Care Continuum: A 1-Year Controlled, Prospective, Randomized Study in Elderly Patients : The Goteborg 70+ Stroke Study Stroke, November 1, 2000; 31(11): 2569 - 2577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. E. Andersen, K. Schultz-Larsen, S. Kreiner, B. H. Forchhammer, K. Eriksen, and A. Brown Can Readmission After Stroke Be Prevented? : Results of a Randomized Clinical Study: A Postdischarge Follow-Up Service for Stroke Survivors Stroke, May 1, 2000; 31(5): 1038 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. Caro, K. F. Huybrechts, and I. Duchesne Management Patterns and Costs of Acute Ischemic Stroke : An International Study Stroke, March 1, 2000; 31(3): 582 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
|
|
|
|
|
|
H. S. Jorgensen, J. Reith, H. Nakayama, L. P. Kammersgaard, H. O. Raaschou, and T. S. Olsen What Determines Good Recovery in Patients With the Most Severe Strokes? : The Copenhagen Stroke Study Stroke, October 1, 1999; 30(10): 2008 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
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]
|
|