Published Online
on September 11, 2003

A more recent version of this article appeared on October 1, 2003

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Submitted on June 16, 2003
Accepted on June 24, 2003

Lifetime Cost of Stroke Subtypes in Australia. Findings From the North East Melbourne Stroke Incidence Study (NEMESIS)

Helen M. Dewey PhD^*; Amanda G. Thrift PhD; Cathy Mihalopoulos BSc, PGradDHE; Robert Carter PhD; Richard A.L. Macdonell MD; John J. McNeil PhD; and Geoffrey A. Donnan MD

From the National Stroke Research Institute (H.M.D., A.G.T., G.A.D.) and Neurology Department (H.M.D., R.A.L.M., G.A.D.), Austin & Repatriation Medical Centre, Heidelberg; Department of Medicine, University of Melbourne, Melbourne (H.M.D., R.A.L.M., G.A.D.); Department of Epidemiology and Preventive Medicine, Monash Medical School, Alfred Hospital, Prahran (A.G.T., J.J.M.); and Centre for Health Program Evaluation, Department of Public Health, University of Melbourne, Heidelberg Heights (C.M., R.C.), Australia.

^* To whom correspondence should be addressed. E-mail: helend{at}austin.unimelb.edu.

Background and Purpose--Little is known about any variations in resource use and costs of care between stroke subtypes, especially nonhospital costs. The purpose of this study was to describe the patterns of resource use and to estimate the first-year and lifetime costs for stroke subtypes.

Methods--A cost-of-illness model was used to estimate the total first-year costs and lifetime costs of stroke subtypes for all strokes (subarachnoid hemorrhages excluded) that occurred in Australia during 1997. For each subtype, average cost per case during the first year and the present value of average cost per case over a lifetime were calculated. Resource use data obtained in the North East Melbourne Stroke Incidence Study (NEMESIS) were used.

Results--The present value of total lifetime costs for all strokes was Aus $1.3 billion (US $985 million). Total lifetime costs were greatest for ischemic stroke (72%; Aus $936.8 million; US $709.7 million), followed by intracerebral hemorrhage (26%; Aus $334.5 million; US $253.4 million) and unclassified stroke (2%; Aus $30 million; US $22.7 million). The average cost per case during the first year was greatest for total anterior circulation infarction (Aus $28 266). Over a lifetime, the present value of average costs was greatest for intracerebral hemorrhage (Aus $73 542), followed by total anterior circulation infarction (Aus $53 020), partial anterior circulation infarction (Aus $50 692), posterior circulation infarction (Aus $37 270), lacunar infarction (Aus $34 470), and unclassified stroke (Aus $12 031).

Conclusions--First-year and lifetime costs vary considerably between stroke subtypes. Variation in average length of total hospital stay is the main explanation for differences in first-year costs.

Key words: Australia • costs and cost analysis • incidence • stroke • stroke classification

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