(Stroke. 1999;30:724-728.)
© 1999 American Heart Association, Inc.
Original Contributions |
Predictors of Acute Hospital Costs for Treatment of Ischemic Stroke in an Academic Center
From the Department of Neurology (M.N.D., D.F.E., P.T.A., C.W.S., A.W.D.) and Program in Occupational Therapy (M.N.D., D.F.E., A.W.D.), Washington University School of Medicine, St Louis, Mo.
Background and Purpose—We sought to determine predictors of acute hospital costs in patients presenting with acute ischemic stroke to an academic center using a stroke management team to coordinate care.
Methods—Demographic and clinical data were prospectively collected on 191 patients consecutively admitted with acute ischemic stroke. Patients were classified by insurance status, premorbid modified Rankin scale, stroke location, stroke severity (National Institutes of Health Stroke Scale score), and presence of comorbidities. Detailed hospital charge data were converted to cost by application of department-specific cost-to-charge ratios. Physician's fees were not included. A stepwise multiple regression analysis was computed to determine the predictors of total hospital cost.
Results—Median length of stay was 6 days (range, 1 to 63 days), and mortality was 3%. Median hospital cost per discharge was $4408 (range, $1199 to $59 799). Fifty percent of costs were for room charges, 19% for stroke evaluation, 21% for medical management, and 7% for acute rehabilitation therapies. Sixteen percent were admitted to an intensive care unit. Length of stay accounted for 43% of the variance in total cost. Other independent predictors of cost included stroke severity, heparin treatment, atrial fibrillation, male sex, ischemic cardiac disease, and premorbid functional status.
Conclusions—We conclude that the major predictors of acute hospital costs of stroke in this environment are length of stay, stroke severity, cardiac disease, male sex, and use of heparin. Room charges accounted for the majority of costs, and attempts to reduce the cost of stroke evaluation would be of marginal value. Efforts to reduce acute costs should be monitored for potential cost shifting or a negative impact on quality of care.
Key Words: costs and cost analysis • outcome • stroke, ischemic • stroke management
This article has been cited by other articles:
 |
|
 |
|
  L.E. Cipriano, M.L. Steinberg, G.S. Gazelle, and R.G. Gonzalez Comparing and Predicting the Costs and Outcomes of Patients with Major and Minor Stroke Using the Boston Acute Stroke Imaging Scale Neuroimaging Classification System AJNR Am. J. Neuroradiol., April 1, 2009; 30(4): 703 - 709. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Luengo-Fernandez, A. M. Gray, and P. M. Rothwell Costs of Stroke Using Patient-Level Data: A Critical Review of the Literature Stroke, February 1, 2009; 40(2): e18 - e23. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, D. Lloyd-Jones, R. Adams, M. Carnethon, G. De Simone, T. B. Ferguson, K. Flegal, E. Ford, K. Furie, A. Go, et al. Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 27, 2009; 119(3): e21 - e181. [Full Text] [PDF]
|
|
|
|
|
|
L. A. Sposato, M. M. Esnaola, R. Zamora, M. C. Zurru, O. Fustinoni, G. Saposnik, on behalf of ReNACer Investigators, and the Argentinian Neurological Society Quality of Ischemic Stroke Care in Emerging Countries: The Argentinian National Stroke Registry (ReNACer) Stroke, November 1, 2008; 39(11): 3036 - 3041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Writing Group Members, W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]
|
|
|
|
|
|
H.-C. Lin, S. Xirasagar, C.-H. Chen, C.-C. Lin, and H.-C. Lee Association Between Physician Volume and Hospitalization Costs for Patients With Stroke in Taiwan: A Nationwide Population-Based Study Stroke, May 1, 2007; 38(5): 1565 - 1569. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Rosamond, K. Flegal, G. Friday, K. Furie, A. Go, K. Greenlund, N. Haase, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2007 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 6, 2007; 115(5): e69 - e171. [Full Text] [PDF]
|
|
|
|
|
|
M. Moodie, D. Cadilhac, D. Pearce, C. Mihalopoulos, R. Carter, S. Davis, G. Donnan, and for the SCOPES Study Group Economic Evaluation of Australian Stroke Services: A Prospective, Multicenter Study Comparing Dedicated Stroke Units With Other Care Modalities Stroke, November 1, 2006; 37(11): 2790 - 2795. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. W. Russell, A. V. Joshi, P. J. Neumann, L. Boulanger, and J. Menzin Predictors of hospital length of stay and cost in patients with intracerebral hemorrhage. Neurology, October 10, 2006; 67(7): 1279 - 1281. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Luengo-Fernandez, A. M. Gray, and P. M. Rothwell Population-Based Study of Determinants of Initial Secondary Care Costs of Acute Stroke in the United Kingdom Stroke, October 1, 2006; 37(10): 2579 - 2587. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Thom, N. Haase, W. Rosamond, V. J. Howard, J. Rumsfeld, T. Manolio, Z.-J. Zheng, K. Flegal, C. O'Donnell, S. Kittner, et al. Heart Disease and Stroke Statistics--2006 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, February 14, 2006; 113(6): e85 - e151. [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]
|
|
|
|
|
|
A. I. Qureshi, M. F. K. Suri, J. F. Kirmani, and A. A. Divani The Relative Impact of Inadequate Primary and Secondary Prevention on Cardiovascular Mortality in the United States Stroke, October 1, 2004; 35(10): 2346 - 2350. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Rundek, K. Nielsen, S. Phillips, K. C. Johnston, M. Hux, D. Watson, and for the GAIN Americas Investigators Health Care Resource Use After Acute Stroke in the Glycine Antagonist in Neuroprotection (GAIN) Americas Trial Stroke, June 1, 2004; 35(6): 1368 - 1374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.-C. Chang and M.-C. Tseng Costs of Acute Care of First-Ever Ischemic Stroke in Taiwan Stroke, November 1, 2003; 34 (11): e219 - e221. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Elkins and S. C. Johnston Thirty-Year Projections for Deaths From Ischemic Stroke in the United States Stroke, September 1, 2003; 34(9): 2109 - 2112. [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]
|
|
|
|
|
|
W.S. Burgin, L. Staub, W. Chan, PhD;, T.H. Wein, R.A. Felberg, J.C. Grotta, A.M. Demchuk, S.L. Hickenbottom, and L.B. Morgenstern Acute stroke care in non-urban emergency departments Neurology, December 11, 2001; 57(11): 2006 - 2012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Krieger, M. A. De Georgia, A. Abou-Chebl, J. C. Andrefsky, C. A. Sila, I. L. Katzan, M. R. Mayberg, and A. J. Furlan Cooling for Acute Ischemic Brain Damage (COOL AID): An Open Pilot Study of Induced Hypothermia in Acute Ischemic Stroke Stroke, August 1, 2001; 32(8): 1847 - 1854. [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]
|
|
|
|
|
|
D. E. Briggs, R. A. Felberg, M. D. Malkoff, P. Bratina, and J. C. Grotta Should Mild or Moderate Stroke Patients Be Admitted to an Intensive Care Unit? Stroke, April 1, 2001; 32(4): 871 - 876. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Lamassa, A. Di Carlo, G. Pracucci, A. M. Basile, G. Trefoloni, P. Vanni, S. Spolveri, M. C. Baruffi, G. Landini, A. Ghetti, et al. Characteristics, Outcome, and Care of Stroke Associated With Atrial Fibrillation in Europe : Data From a Multicenter Multinational Hospital-Based Registry (The European Community Stroke Project) Stroke, February 1, 2001; 32(2): 392 - 398. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Kalafut, R. Gandhi, C. S. Kidwell, and J. L. Saver Safety and Cost of Low-Molecular-Weight Heparin as Bridging Anticoagulant Therapy in Subacute Cerebral Ischemia Stroke, November 1, 2000; 31(11): 2563 - 2568. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
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]
|
|
|
|
|
|
T. Rundek, H. Mast, A. Hartmann, B. Boden-Albala, L. Lennihan, I.-F. Lin, M. C. Paik, and R. L. Sacco Predictors of resource use after acute hospitalization: The Northern Manhattan Stroke Study Neurology, October 24, 2000; 55(8): 1180 - 1187. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Sulch, I. Perez, A. Melbourn, and L. Kalra Randomized Controlled Trial of Integrated (Managed) Care Pathway for Stroke Rehabilitation Stroke, August 1, 2000; 31(8): 1929 - 1934. [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]
|
|