The cost of stroke in private hospitals in Brazil: a one-year prospective study

• Published in: Arquivos de neuro-psiquiatria Vol. 77; no. 6; pp. 393 - 403
• Main Authors: Vieira, Luana Gabriela Dalla Rosa, Safanelli, Juliana, Araujo, Tainá de, Schuch, Helen Aparecida, Kuhlhoff, Maria Helena Ribeiro, Nagel, Vivian, Conforto, Adriana Bastos, Silva, Gisele Sampaio, Mazin, Suleimy, Cabral, Norberto Luiz
• Format: Journal Article
• Language: English
• Published: Brazil Arquivos de Neuro-Psiquiatria 01-06-2019; Academia Brasileira de Neurologia - ABNEURO; Academia Brasileira de Neurologia (ABNEURO)
• Subjects: Aged; Aged, 80 and over; Aneurysms; Brazil; Cerebral Hemorrhage - economics; costs and cost analysis; Female; Health Care Costs - statistics & numerical data; Hospitals; Hospitals, Private - economics; Humans; Intravenous administration; Ischemia; Ischemic Attack, Transient - economics; Length of Stay - economics; Low income groups; Male; Middle Aged; NEUROSCIENCES; Patients; Prospective Studies; PSYCHIATRY; Reference Values; Reperfusion; Severity of Illness Index; Statistics, Nonparametric; Stroke; Stroke - economics; Stroke - therapy; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - economics; Thrombolysis; Time Factors; Brazil; United States > US; hospitals; Stroke; custo e análise de custo; costs and cost analysis; hospitais; Acidente vascular cerebral
• ISSN: 0004-282X; 1678-4227; 1678-4227
• DOI: 10.1590/0004-282x20190056

Few studies from low- and middle-income countries have assessed stroke and cerebral reperfusion costs from the private sector. To measure the in-hospital costs of ischemic stroke (IS), with and without cerebral reperfusion, primary intracerebral hemorrhage (PIH), subarachnoid hemorrhage (SAH) and transient ischemic attacks (TIA) in two private hospitals in Joinville, Brazil.
Prospective disease-cost study. All medical and nonmedical costs for patients admitted with any stroke type or TIA were consecutively determined in 2016-17. All costs were adjusted to the gross domestic product deflator index and purchasing power parity.
We included 173 patients. The median cost per patient was US$3,827 (IQR: 2,800-8,664) for the 131 IS patients; US$2,315 (IQR: 1,692-2,959) for the 27 TIA patients; US$16,442 (IQR: 5,108-33,355) for the 11 PIH patients and US$28,928 (IQR: 12,424-48,037) for the four SAH patients (p < 0.00001). For the six IS patients who underwent intravenous thrombolysis, the median cost per patient was US$11,463 (IQR: 8,931-14,291), and for the four IS patients who underwent intra-arterial thrombectomy, the median cost per patient was US$35,092 (IQR: 31,833-37,626; p < 0.0001). A direct correlation was found between cost and length of stay (r = 0.67, p < 0.001).
Stroke is a costly disease. In the private sector, the costs of cerebral reperfusion for IS treatment were three-to-ten times higher than for usual treatments. Therefore, cost-effectiveness studies are urgently needed in low- and middle-income countries.