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(Stroke. 2009;40:1425.)
© 2009 American Heart Association, Inc.

Original Contributions

Additional Stroke-Related and Non–Stroke-Related Cardiovascular Costs and Hospitalizations in Managed-Care Patients After Ischemic Stroke

Craig S. Roberts, PharmD, MPA; Philip B. Gorelick, MD, MPH; Xin Ye, PhD; Carolyn Harley, PhD George A. Goldberg, MD

From Pfizer Inc (C.S.R.), New York, NY; the University of Illinois at Chicago (P.B.G.); and i3 Innovus, Eden Prairie, Minn (X.Y., C.H.), and Santa Monica, Calif (G.A.G.).

Correspondence to Craig S. Roberts, PharmD, MPA, Global Outcomes Research, Pfizer Inc, 235 East 42nd St, New York, NY 10017. E-mail Craig.Roberts{at}pfizer.com

Background and Purpose— Prior stroke confers an increased risk of future cardiovascular events. Because the incremental economic impact of this added risk is unknown, we assessed the additional cardiovascular costs and hospitalizations associated with ischemic stroke.

Methods— Patients hospitalized for ischemic stroke during 2002 to 2005 were identified from a large US managed-care plan and matched to control patients hospitalized for a noncardiovascular acute event. Cumulative stroke-related and non–stroke-related cardiovascular medical costs were determined for each group. Stroke and nonstroke cardiovascular hospitalization rates were calculated with the Kaplan–Meier method; risk of hospitalization was estimated with a Cox regression model.

Results— Stroke patients and matched controls (N=11 883) were identified (mean age 58 years; 47.8% female). Compared with controls, patients hospitalized for ischemic stroke had higher stroke and nonstroke cardiovascular medical costs at 6 months (stroke: $1756 vs $50, P<0.01; nonstroke cardiovascular: $1437 vs $658, P<0.01) and 12 months (stroke: $2109 vs $68, P<0.01; nonstroke cardiovascular: $2203 vs $1167, P<0.01) of follow-up. Among stroke patients, cumulative stroke and nonstroke cardiovascular hospitalization rates were 9.06% and 5.63% at 6 months, respectively, and 21.09% and 22.05% at 36 months, respectively. Stroke patients were at significantly increased risk of repeat stroke hospitalization (hazard ratio=12.55; 95% CI, 10.50 to 15.01) and nonstroke cardiovascular hospitalization (hazard ratio=1.95; 95% CI, 1.77 to 2.14).

Conclusions— After ischemic stroke, patients have significantly greater stroke and nonstroke cardiovascular costs and hospitalizations than do matched controls. Attention to total cardiovascular risk reduction in this population could potentially reduce downstream costs.

Key Words: stroke • health care costs • hospitalization • risk factors • managed care