Medicine (Austin & Northern Health) - Theses
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ItemComparing the costs of stroke subtypes: a cost of illness study( 2000)Worldwide, stroke is the second leading cause of death and one of the most important causes of disability. Stroke is responsible for about 4% of the total costs of disease in Australia. Apart from this study, there are no data about the patterns of health care and community resource use among distinct subtypes of stroke patients in Australia. The role of informal carers in the care of stroke survivors has not previously been investigated, and, with the exception of this study, there are no Australian data about the costs personally incurred by patients and their carers for stroke-related medical and community services. A community-based stroke incidence study conforming to 'ideal' methodology was conducted in urban Melbourne (population 133,816) during 1996 and 1997. All registered cases (380 events in 352 persons) were classified into distinct stroke subtypes. The crude annual incidence rate (first-ever strokes) was 206 per 100,000 per year. Details of stroke-related resource use during the first 12 months after stroke were obtained for 165 cases. Methods included face-to-face interviews conducted by research nurses with patients and carers. An incidence-based cost-of-illness model was developed which linked subtype-specific incidence rates, mortality rates and resource use data. The total first year costs and the present value of total lifetime costs for all first-ever-in-a-lifetime stroke cases occurring in Australia in 1997 were estimated to be $A541.3 million and $A1.3 billion respectively. The average total costs during the first year and the average present value of total costs over a lifetime following first-ever-in-a-Iifetime stroke were $18,483/case and $43,565/case respectively. The estimated total cost of inpatient rehabilitation for all first-ever-in-a-lifetime stroke cases occurring in Australia in 1997 was $A150 million. This is similar to the total cost of hospitalisation for acute stroke care and approximately twice that of a previous estimate. The 'time costs' of informal care provided by relatives and friends represented about 4% of total first year costs and 14% of total lifetime costs for first-ever-in-a-lifetime strokes. Virtually all surviving stroke cases reported 'out of pocket' costs as a consequence of stroke. The largest costs were for home modifications, private nursing care and aids and equipment. A clear relationship between stroke subtype and cost was demonstrated. During the first year after stroke, although the average cost per case was similar for cerebral infarction and intracerebral haemorrhage, large cost differences were demonstrated between subtypes of cerebral infarction. The most expensive infarct subtype was Total Anterior Cerebral Infarction (TACI) and the least expensive was Lacunar Infarction (LACI). On average, cases of TACI costed 1.8 times as much as cases of LACI. Over a lifetime, on average, cases of intracerebral haemorrhage costed 1.7 times as much as cases of cerebral infarction and cases of LACI cost two-thirds as much as TACI. This is the first comprehensive description of the patterns and costs of stroke care during the first year after stroke in Australia. Given the magnitude of the costs of stroke rehabilitation in this study, formal evaluation of the cost-effectiveness of these services needs to become a research priority.