The cost of stroke in a public hospital in Brazil: a one-year prospective study
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. T...
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| Published in: | Arquivos de neuro-psiquiatria Vol. 77; no. 6; pp. 404 - 411 |
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| Language: | English |
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Brazil
Arquivos de Neuro-Psiquiatria
01-06-2019
Academia Brasileira de Neurologia - ABNEURO Academia Brasileira de Neurologia (ABNEURO) |
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| Abstract | 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. |
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| AbstractList | OBJECTIVELow- 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. METHODSWe 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. RESULTSWe 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. CONCLUSIONSReperfusion treatments were two-to-four times more expensive than conservative treatment. A cost-effectiveness study of the IS treatment option is necessary. ABSTRACT 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. Objective To measure the costs of stroke care in a public hospital in Joinville, Brazil. Methods 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. Results 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. Conclusions Reperfusion treatments were two-to-four times more expensive than conservative treatment. A cost-effectiveness study of the IS treatment option is necessary. 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. Objective: To measure the costs of stroke care in a public hospital in Joinville, Brazil. Methods: 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. Results: 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. Conclusions: Reperfusion treatments were two-to-four times more expensive than conservative treatment. A cost-effectiveness study of the IS treatment option is necessary. ABSTRACT 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. Objective To measure the costs of stroke care in a public hospital in Joinville, Brazil. Methods 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. Results 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$2,677, respectively. Conclusions Reperfusion treatments were two-to-four times more expensive than conservative treatment. A cost-effectiveness study of the IS treatment option is necessary. RESUMO Os países de baixa e media renda enfrentam orçamentos apertados na saúde, não somente devido aos novos recursos terapêuticos, mas relacionado ao custo oneroso do tratamento do acidente vascular cerebral. No entanto, poucos dados prospectivos sobre os custos do AVC, incluindo reperfusão cerebral de países de baixa e média renda estão disponíveis. Objetivo Mensurar os custos do atendimento ao AVC em um hospital público. Métodos Avaliamos prospectivamente todos os custos médicos e não médicos de pacientes internados com diagnóstico de acidente vascular cerebral ou AIT durante 1 ano, analisamos os custos por tipo de AVC e tratamento, tempo de permanência e comparamos os custos hospitalares com o reembolso governamental. Resultados Foram avaliados 274 pacientes. O custo total em um ano foi de US$ 1.307,114; o governo reembolsou o hospital no valor de US$ 1.095.118. Encontramos uma correlação linear significativa entre LOS e custos (r = 0,71). A mediana do custo do AVCI em 134 pacientes que não sofreram reperfusão cerebral (National Institutes of Health Stroke Scale [NIHSS] mediana = 3) foi de US$ 2.803; para pacientes submetidos a alteplase intravenosa (IV) (NIHSS 10), a mediana foi de US$ 5.099 e para os pacientes submetidos a trombectomia intra-arterial (IA) (NIHSS > 10), o custo mediano foi de US$ 10.997. A mediana do custo de uma hemorragia intracerebral primária, hemorragia subaracnóidea e AIT foram de US$ 2.436, US$ 8.031 e US$ 2.677, respectivamente. Conclusões Os tratamentos de reperfusão foram duas a quatro vezes mais caros do que o tratamento conservador. Estudo de custo-efetividade para o tratamento do AVC são necessários. 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. |
| Author | Araujo, Tainá de Nagel, Vivian Silva, Gisele Sampaio Vieira, Luana Gabriela Dalla Rosa Cabral, Norberto Luiz Conforto, Adriana Bastos Magalhães, Pedro Silva Corrêa de Safanelli, Juliana Kuhlhoff, Maria Helena Ribeiro Mazin, Suleimy Manchope, Lidiana Fachinete Silva |
| AuthorAffiliation | Hospital Israelita Albert Einstein Universidade da Região de Joinville Universidade de São Paulo de Ribeirão Preto Hospital Municipal São José Universidade de São Paulo Universidade Federal de São Paulo |
| AuthorAffiliation_xml | – name: Universidade de São Paulo – name: Hospital Municipal São José – name: Hospital Israelita Albert Einstein – name: Universidade Federal de São Paulo – name: Universidade de São Paulo de Ribeirão Preto – name: Universidade da Região de Joinville |
| Author_xml | – sequence: 1 givenname: Juliana orcidid: 0000-0003-1924-8279 surname: Safanelli fullname: Safanelli, Juliana organization: Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil – sequence: 2 givenname: Luana Gabriela Dalla Rosa orcidid: 0000-0003-4317-6914 surname: Vieira fullname: Vieira, Luana Gabriela Dalla Rosa organization: Universidade da Região de Joinville, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil – sequence: 3 givenname: Tainá de orcidid: 0000-0001-6558-5415 surname: Araujo fullname: Araujo, Tainá de organization: Universidade da Região de Joinville, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil – sequence: 4 givenname: Lidiana Fachinete Silva orcidid: 0000-0003-1480-1223 surname: Manchope fullname: Manchope, Lidiana Fachinete Silva organization: Universidade da Região de Joinville, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil – sequence: 5 givenname: Maria Helena Ribeiro orcidid: 0000-0003-1384-9444 surname: Kuhlhoff fullname: Kuhlhoff, Maria Helena Ribeiro organization: Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil – sequence: 6 givenname: Vivian orcidid: 0000-0002-3321-6110 surname: Nagel fullname: Nagel, Vivian organization: Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil – sequence: 7 givenname: Adriana Bastos orcidid: 0000-0001-7869-3490 surname: Conforto fullname: Conforto, Adriana Bastos organization: Hospital Israelita Albert Einstein, São Paulo, SP, Brasil – sequence: 8 givenname: Gisele Sampaio orcidid: 0000-0002-3247-3123 surname: Silva fullname: Silva, Gisele Sampaio organization: Universidade de São Paulo, Hospital das Clínicas, São Paulo, SP, Brasil – sequence: 9 givenname: Suleimy orcidid: 0000-0001-6121-7295 surname: Mazin fullname: Mazin, Suleimy organization: Universidade de São Paulo de Ribeirão Preto, Hospital das Clínicas, Ribeirão Preto, SP, Brasil – sequence: 10 givenname: Pedro Silva Corrêa de orcidid: 0000-0001-7297-1381 surname: Magalhães fullname: Magalhães, Pedro Silva Corrêa de organization: Hospital Municipal São José, Unidade de AVC, Joinville, SC, Brasil – sequence: 11 givenname: Norberto Luiz orcidid: 0000-0001-5829-9699 surname: Cabral fullname: Cabral, Norberto Luiz organization: Universidade da Região de Joinville, Joinville Stroke Registry, Programa de Pós-Graduação em Saúde e Meio Ambiente, Joinville, SC, Brasil |
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| Keywords | custos hospitalares Stroke fatores socioeconômicos hospital custs efeitos psicossocias da doença socioeconomic factors cost of illness Acidente vascular cerebral |
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– year: 2010 publication-title: Troca de informações em saúde suplementar – volume: 10 start-page: 320 issue: 4 year: 2000 end-page: 326 article-title: Hospital costs for stroke care in Singapore publication-title: Cerebrovasc Dis contributor: fullname: Venketasubramanian, N; Yin, A – volume: 5 start-page: 1 year: 2016 end-page: 6 article-title: Intravenous rtPA versus mechanical thrombectomy in acute ischemic stroke: A historical cohort in Joinville, Brazil publication-title: eNeurologicalSci contributor: fullname: Cabral, NL; Conforto, A; Magalhaes, PS; Longo, AL; Moro, CH; Appel, H – volume: 377 start-page: 1778 issue: 9779 year: 2011 end-page: 1797 article-title: The Brazilian health system: history, advances, and challenges publication-title: Lancet contributor: fullname: Paim, J; Travassos, C; Almeida, C; Bahia, L; Macinko, J – volume: 113 start-page: 111 issue: 2 year: 2011 end-page: 114 article-title: Cost of acute ischemic and hemorrhagic stroke in Turkey publication-title: Clin Neurol Neurosurg contributor: fullname: Asil, T; Celik, Y; Sut, N; Celik, AD; Balci, K; Yilmaz, A – volume: 119 start-page: 246 issue: 4 year: 2009 end-page: 253 article-title: Acute treatment costs of intracerebral hemorrhage and ischemic stroke in Argentina publication-title: Acta Neurol Scand contributor: fullname: Christensen, MC; Previgliano, I; Capparelli, FJ; Lerman, D; Lee, WC; Wainsztein, NA – volume: 61 start-page: 627 issue: 6 year: 2013 end-page: 632 article-title: Cost of stroke from a tertiary center in northwest India publication-title: Neurol India contributor: fullname: Kwatra, G; Kaur, P; Toor, G; Badyal, DK; Kaur, R; Singh, Y – volume: 383 start-page: 245 issue: 9913 year: 2014 end-page: 254 article-title: Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010 publication-title: Lancet contributor: fullname: Feigin, VL; Forouzanfar, MH; Krishnamurthi, R; Mensah, GA; Connor, M; Bennett, DA – volume: 3 start-page: 24 issue: 2 year: 2008 end-page: 47 article-title: Uso do Custeio por Absorção e do Sistema RKW para gerar informações gerenciais: um estudo de caso em hospital publication-title: AB Custos contributor: fullname: Beuren, IM; Schlindwein, NF – volume: 67 start-page: 473 issue: 5 year: 2012 end-page: 477 article-title: Direct medical cost of stroke: findings from a tertiary hospital in malaysia publication-title: Med J Malaysia contributor: fullname: Nor Azlin, MN; Syed Aljunid, SJ; Noor Azahz, A; Amrizal, MN; Saperi, S – volume: 71 start-page: 1872 issue: 10 year: 2010 end-page: 1881 article-title: Examining cost variation across hospital departments—a two-stage multi-level approach using patient-level data publication-title: Soc Sci Med contributor: fullname: Laudicella, M; Olsen, KR; Street, A – volume: 85 start-page: 403 issue: 3 year: 1996 end-page: 409 article-title: Hospital resource utilization in the treatment of cerebral aneurysms publication-title: J Neurosurg contributor: fullname: Yundt, KD; Dacey Jr, RG; Diringer, MN – volume: 22 start-page: 3225 issue: 10 year: 2017 end-page: 3234 article-title: Health protection in Brazil: the National Sanitary Surveillance System publication-title: Cien Saude Colet contributor: fullname: Seta, MH; Oliveira, CV; Pepe, VL – volume: 17 start-page: 158 issue: 1 year: 2017 article-title: Hospital treatment costs and length of stay associated with hypertension and multimorbidity after hemorrhagic stroke publication-title: BMC Neurol contributor: fullname: Specogna, AV; Turin, TC; Patten, SB; Hill, MD – volume: 32 start-page: 2409 issue: 10 year: 2001 end-page: 2416 article-title: Cost of stroke in Australia from a societal perspective: results from the North East Melbourne Stroke Incidence Study (NEMESIS) publication-title: Stroke contributor: fullname: Dewey, HM; Thrift, AG; Mihalopoulos, C; Carter, R; Macdonell, RA; McNeil, JJ – volume: 32 start-page: 142 issue: 2 year: 2009 end-page: 149 article-title: Acute treatment costs of stroke in Brazil publication-title: Neuroepidemiology contributor: fullname: Christensen, MC; Valiente, R; Sampaio Silva, G; Lee, WC; Dutcher, S; Guimarães Rocha, MS – volume: 46 start-page: 249 issue: 3 year: 2002 end-page: 251 article-title: Comparison of cost and outcome of endovascular and neurosurgical procedures in the treatment of ruptured intracranial aneurysms publication-title: Australas Radiol contributor: fullname: Bairstow, P; Dodgson, A; Linto, J; Khangure, M – year: 2010 publication-title: Tabela unificada – volume: 5 start-page: 1 issue: 9 year: 2010 end-page: 9 article-title: Variations and determinants of hospital costs for acute stroke in China publication-title: PLoS One contributor: fullname: Wei, JW; Heeley, EL; Jan, S; Huang, Y; Huang, Q; Wang, JG – volume: 95 start-page: 1266 issue: 10 year: 2012 end-page: 1277 article-title: Cost of acute and sub-acute care for stroke patients publication-title: J Med Assoc Thai contributor: fullname: Khiaocharoen, O; Pannarunothai, S; Zungsontiporn, C – volume: 35 start-page: 1209 issue: 5 year: 2004 end-page: 1215 article-title: International comparison of stroke cost studies publication-title: Stroke contributor: fullname: Evers, SM; Struijs, JN; Ament, AJ; Genugten, ML; Jager, JH; Bos, GA – volume: 6 start-page: 51 issue: 1 year: 2010 end-page: 59 article-title: A web-based tool for adjusting costs to a specific target currency and price year publication-title: Evid Policy contributor: fullname: Shemilt, I; Thomas, J; Morciano, M – volume: 8 start-page: 147 issue: 1-4 year: 2005 end-page: 167 article-title: Cost of stroke in Canada: a 1-year prospective study publication-title: J Med Econ contributor: fullname: Goeree, R; Blackhouse, G; Petrovic, R; Salama, S – volume: 48 start-page: 2925 issue: 11 year: 2017 end-page: 2930 article-title: Increase of stroke incidence in young adults in a middle-income country: a 10-year population-based study publication-title: Stroke contributor: fullname: Cabral, NL; Freire, AT; Conforto, AB; Santos, N; Reis, FI; Nagel, V – publication-title: Serviços/SIHSUS – year: 2013 publication-title: Manual de rotinas para atenção ao AVC – volume: 53 start-page: 552 issue: 11 year: 2003 end-page: 555 article-title: Cost of acute stroke care at a tertiary care hospital in Karachi, Pakistan publication-title: J Pak Med Assoc contributor: fullname: Khealani, BA; Javed, ZF; Syed, NA; Shafqat, S; Wasay, M – volume: 26 start-page: 1830 issue: 10 year: 1995 end-page: 1836 article-title: Costs of medical care after first-ever stroke in The Netherlands publication-title: Stroke contributor: fullname: Bergman, L; van der Meulen, JH; Limburg, M; Habbema, JD – volume: 43 start-page: 1131 issue: 4 year: 2012 end-page: 1133 article-title: Hospitalization costs for acute ischemic stroke patients treated with intravenous thrombolysis in the United States are substantially higher than medicare payments publication-title: Stroke contributor: fullname: Brinjikji, W; Rabinstein, AA; Cloft, HJ – volume: 20 start-page: 864 issue: 7 year: 1989 end-page: 870 article-title: Measurements of acute cerebral infarction: a clinical examination scale publication-title: Stroke contributor: fullname: Brott, T; Adams Jr, HP; Olinger, CP; Marler, JR; Barsan, WG; Biller, J |
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| Snippet | Low- and middle-income countries face tight health care budgets, not only new resources, but also costly therapeutic resources for treatment of ischemic stroke... ABSTRACT Low- and middle-income countries face tight health care budgets, not only new resources, but also costly therapeutic resources for treatment of... OBJECTIVELow- and middle-income countries face tight health care budgets, not only new resources, but also costly therapeutic resources for treatment of... |
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| SubjectTerms | 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 |
| Title | The cost of stroke in a public hospital in Brazil: a one-year prospective study |
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