Centre for Research on Health and Social Care Management (CERGAS) and SDA Bocconi, Università Bocconi, Milan, Italy.
BMC Neurol. 2012 Nov 14;12:137. doi: 10.1186/1471-2377-12-137.
The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission.
The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs) and productivity losses. The relation between costs of stroke management and socio-demographic and clinical characteristics as well as disability levels was evaluated in a series of bivariate analyses using non parametric tests (Mann Whitney and Kruskal-Wallis). Multiple linear regression analyses were performed to determine predictors of costs incurred by stroke patients during the acute phase and follow-up of 1 year.
On average, one-year healthcare and societal costs amounted to €11,747 and € 19,953 per stroke survivor, respectively. The major cost component of societal costs was informal care accounting for € 6,656 (33.4% of total), followed by the initial hospitalisation, (€ 5,573; 27.9% of total), rehabilitation during follow up (€ 4,112; 20.6 %), readmissions (€ 439) and specialist and general practioner visits (€ 326). Mean drug costs per patient over the follow-up period was about € 50 per month. Costs associated to the provision of paid and informal care followed different pattern and were persistent over time (ranging from € 639 to € 597 per month in the first and the second part of the year, respectively). Clinical variables (presence of diabetes mellitus and hemorrhagic stroke) were significant predictors of total healthcare costs while functional outcomes (Barthel Index and Modified Ranking Scale scores) were significantly associated with both healthcare and societal costs at one year.
The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate "social" support.
本研究旨在估计意大利因卒中事件导致的一年期社会成本，并调查与住院后不同阶段成本相关的变量。
在全国 44 家医院招募患者，在入院、出院及卒中后 3、6 和 12 个月时前瞻性调查 411 名卒中幸存者的社会人口统计学、临床变量和资源消耗数据。我们采用微观成本核算程序来确定产生成本的组成部分，并为三个成本类别（直接医疗保健、直接非医疗保健（包括非正式护理成本）和生产力损失）分配适当的单位成本。使用非参数检验（Mann-Whitney 和 Kruskal-Wallis）在一系列单变量分析中评估卒中管理成本与社会人口统计学和临床特征以及残疾程度之间的关系。使用多元线性回归分析确定卒中患者在急性阶段和 1 年随访期间的成本预测因素。
平均而言，每位卒中幸存者 1 年的医疗保健和社会成本分别为 11747 欧元和 19953 欧元。社会成本的主要成本构成部分是非正式护理，占 6656 欧元（占总成本的 33.4%），其次是初始住院治疗（5573 欧元；占总成本的 27.9%）、随访期间的康复治疗（4112 欧元；占总成本的 20.6%）、再入院（439 欧元）和专科医生和全科医生就诊（326 欧元）。随访期间每位患者的平均药物费用约为每月 50 欧元。提供有偿和无偿护理的相关费用遵循不同的模式，并随时间持续存在（分别为每月 639 欧元和 597 欧元，第一和第二年的后半部分）。临床变量（糖尿病和出血性卒中的存在）是医疗保健总费用的显著预测因素，而功能结局（巴氏指数和改良Rankin 量表评分）与 1 年内的医疗保健和社会成本显著相关。
非正式护理在卒中管理中的重要作用以及成本随时间的不同分布表明，适当的规划应同时考虑新发和现患卒中病例，以预测卫生基础设施需求，更重要的是，确保卒中患者有足够的“社会”支持。
