The cost of stroke in a public hospital in Brazil: a one-year prospective study

• Published in: Arquivos de neuro-psiquiatria Vol. 77; no. 6; pp. 404 - 411
• Main Authors: Safanelli, Juliana, Vieira, Luana Gabriela Dalla Rosa, Araujo, Tainá de, Manchope, Lidiana Fachinete Silva, Kuhlhoff, Maria Helena Ribeiro, Nagel, Vivian, Conforto, Adriana Bastos, Silva, Gisele Sampaio, Mazin, Suleimy, Magalhães, Pedro Silva Corrêa de, 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: Adult; Aged; Aged, 80 and over; Brazil; Cerebral Hemorrhage - economics; cost of illness; Female; Health Care Costs - statistics & numerical data; Hospital costs; hospital custs; Hospitals, Public - 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; socioeconomic factors; Statistics, Nonparametric; Stroke; Stroke - economics; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - economics; Time Factors; Transient ischemic attack; Brazil; United States > US; custos hospitalares; Stroke; fatores socioeconômicos; hospital custs; efeitos psicossocias da doença; socioeconomic factors; cost of illness; Acidente vascular cerebral
• ISSN: 0004-282X; 1678-4227; 1678-4227
• DOI: 10.1590/0004-282X20190059

Low- and middle-income countries face tight health care budgets, not only new resources, but also costly therapeutic resources for treatment of ischemic stroke (IS). However, few prospective data about stroke costs including cerebral reperfusion from low- and middle-income countries are available. To measure the costs of stroke care in a public hospital in Joinville, Brazil.
We prospectively assessed all medical and nonmedical costs of inpatients admitted with a diagnosis of any stroke or transient ischemic attack over one year, analyzed costs per type of stroke and treatment, length of stay (LOS) and compared hospital costs with government reimbursement.
We evaluated 274 patients. The total cost for the year was US$1,307,114; the government reimbursed the hospital US$1,095,118. We found a significant linear correlation between LOS and costs (r = 0.71). The median cost of 134 IS inpatients who did not undergo cerebral reperfusion (National Institutes of Health Stroke Scale [NIHSS] median = 3 ) was US$2,803; for IS patients who underwent intravenous (IV) alteplase (NIHSS 10), the median was US$5,099, and for IS patients who underwent IV plus an intra-arterial (IA) thrombectomy (NIHSS > 10), the median cost was US$10,997. The median costs of a primary intracerebral hemorrhage, subarachnoid hemorrhage, and transient ischemic attack were US$2,436, US$8,031 and US$2,677, respectively.
Reperfusion treatments were two-to-four times more expensive than conservative treatment. A cost-effectiveness study of the IS treatment option is necessary.