Costs From Brain Bleeds Escalate With Time

Published: Oct 23, 2014

By Shara Yurkiewicz , Staff Writer, MedPage Today

Average direct care costs in patients with intracerebral hemorrhage (ICH) increased markedly year over year in people surviving 10 years, researchers reported.

Annual costs for ischemic stroke survivors, on the other hand, remained about the same over the 10-year time frame, between $5,000 and $5,500 over years three to 10, according to a study by Tristan Gloede, Dipl.Ges.-Ök, at the University of Cologne in Germany, and colleagues, published online in Stroke.

Given no decreases in direct costs after 5 years for ischemic stroke, "overall direct costs at 5 years may be considered a good predictor of long-term direct costs," authors wrote. Stroke costs are highest within the first year and then decline over time, they added. But the cost trajectory beyond 5 years out had not previously been studied closely, Gloede and colleagues noted.

Most studies of long-term costs had simply extrapolated patterns seen in the first 5 years. The current study "contributes to a better understanding of the long-term costs of stroke than when a shorter follow-up time frame is used," wrote the researchers.

Their analysis was based on epidemiological data from the North East Melbourne Stroke Incidence Study(NEMESIS), which looked at strokes occurring in a population of more than 100,000 residents in Melbourne, Australia. Some 31,000 individuals in the cohort experienced strokes, of which about 17% were ICH events.

NEMESIS participants who were alive after 10 years were interviewed about resource use and costs. These included elderly care facilities, medication costs, community services, inpatient rehabilitation, general practitioner care, hospitalizations for complications, and other direct medical costs.

The average direct costs in the first year totaled $19,992 U.S. dollars for ischemic stroke patients and $11,796 for ICH patients.

Between years three and five, average annual costs were $5,438 for ischemic stroke patients and $5,807 for ICH patients, when informal care and out-of-pocket costs were included.

At 10 years, the annual cost of direct care for IS patients stayed stable at $5,207.

But for ICH patients, annual cost increased by 31% to $7,607. The same patterns were evident when only direct medical costs were considered.

"The cost drivers at 10 years highlighted greater costs for medication and aged-care facilities and lower costs for inpatient rehabilitation and informal care," authors wrote.

Limitations include a possible lack of generalizability given socioeconomic differences in the population being studied, as well as no inclusion of costs for patients who had passed away.