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(Stroke. 2009;40:915.)
© 2009 American Heart Association, Inc.

Original Contributions

Estimating the Long-Term Costs Of Ischemic and Hemorrhagic Stroke for Australia

New Evidence Derived From the North East Melbourne Stroke Incidence Study (NEMESIS)

Dominique A. Cadilhac, PhD; Rob Carter, PhD; Amanda G. Thrift, PhD Helen M. Dewey, PhD

From the National Stroke Research Institute (D.A.C., A.G.T., H.M.D.), Victoria, Australia; the Department of Medicine (D.A.C., H.M.D.), The University of Melbourne, Australia; the Health Economics Unit (D.A.C., R.C.), Deakin University, Burwood, Australia; the Baker Heart & Diabetes Institute (A.G.T.), Melbourne, Australia; the Department of Epidemiology & Preventive Medicine (A.G.T.), Monash University, Melbourne, Australia; and the Department of Neurology (H.M.D.), Austin Health, Heidelberg, Australia.

Correspondence to Dominique A. Cadilhac, National Stroke Research Institute, Level 1 Neurosciences Building, Repatriation Hospital, 300 Waterdale Road, Heidelberg Heights, Vic, Australia 3081. E-mail dcadilhac{at}nsri.org.au

Background and Purpose— Stroke is associated with considerable societal costs. Cost-of-illness studies have been undertaken to estimate lifetime costs; most incorporating data up to 12 months after stroke. Costs of stroke, incorporating data collected up to 12 months, have previously been reported from the North East Melbourne Stroke Incidence Study (NEMESIS). NEMESIS now has patient-level resource use data for 5 years. We aimed to recalculate the long-term resource utilization of first-ever stroke patients and compare these to previous estimates obtained using data collected to 12 months.

Methods— Population structure, life expectancy, and unit prices within the original cost-of-illness models were updated from 1997 to 2004. New Australian stroke survival and recurrence data up to 10 years were incorporated, as well as cross-sectional resource utilization data at 3, 4, and 5 years from NEMESIS. To enable comparisons, 1997 costs were inflated to 2004 prices and discounting was standardized.

Results— In 2004, 27 291 ischemic stroke (IS) and 4291 intracerebral hemorrhagic stroke (ICH) first-ever events were estimated. Average annual resource use after 12 months was AU$6022 for IS and AU$3977 for ICH. This is greater than the 1997 estimates for IS (AU$4848) and less than those for ICH (previously AU$10 692). The recalculated average lifetime costs per first-ever case differed for IS (AU$57 106 versus AU$52 855 [1997]), but differed more for ICH (AU$49 995 versus AU$92 308 [1997]).

Conclusion— Basing lifetime cost estimates on short-term data overestimated the costs for ICH and underestimated those for IS. Patterns of resource use varied by stroke subtype and, overall, the societal cost impact was large.

Key Words: cerebral infarct • intracerebral hemorrhage • costs • economics • outcomes