Buisman Leander R, Tan Siok Swan, Nederkoorn Paul J, Koudstaal Peter J, Redekop William K
From the Institute of Health Policy and Management (L.R.B., S.S.T., W.K.R.) and the Institute for Medical Technology Assessment (L.R.B., S.S.T., W.K.R.), Erasmus University Rotterdam; the Department of Neurology (P.J.N.), Academic Medical Center, University of Amsterdam; and the Department of Neurology (P.J.K.), Erasmus MC, University Medical Center Rotterdam, the Netherlands.
Neurology. 2015 Jun 2;84(22):2208-15. doi: 10.1212/WNL.0000000000001635. Epub 2015 May 1.
There have been no ischemic stroke costing studies since major improvements were implemented in stroke care. We therefore determined hospital resource use and costs of ischemic stroke and TIA in the Netherlands for 2012.
We conducted a retrospective cost analysis using individual patient data from a national diagnosis-related group registry. We analyzed 4 subgroups: inpatient ischemic stroke, inpatient TIA, outpatient ischemic stroke, and outpatient TIA. Costs of carotid endarterectomy and costs of an extra follow-up visit were also estimated. Unit costs were based on reference prices from the Dutch Healthcare Insurance Board and tariffs provided by the Dutch Healthcare Authority. Linear regression analysis was used to examine the association between hospital costs and various patient and hospital characteristics.
A total of 35,903 ischemic stroke and 21,653 TIA patients were included. Inpatient costs were €5,328 ($6,845) for ischemic stroke and €2,470 ($3,173) for TIA. Outpatient costs were €495 ($636) for ischemic stroke and €587 ($754) for TIA. Costs of carotid endarterectomy were €6,836 ($8,783). Costs of inpatient days were the largest contributor to hospital costs. Age, hospital type, and region were strongly associated with hospital costs.
Hospital costs are higher for inpatients and ischemic strokes compared with outpatients and TIAs, with length of stay (LOS) the most important contributor. LOS and hospital costs have substantially declined over the last 10 years, possibly due to improved hospital stroke care and efficient integrated stroke services.
自从在中风护理方面实施重大改进措施以来，尚未有关于缺血性中风成本的研究。因此，我们确定了2012年荷兰缺血性中风和短暂性脑缺血发作（TIA）的医院资源使用情况及成本。
我们使用来自全国诊断相关组登记处的个体患者数据进行了一项回顾性成本分析。我们分析了4个亚组：住院缺血性中风、住院TIA、门诊缺血性中风和门诊TIA。还估算了颈动脉内膜切除术的成本以及额外随访就诊的成本。单位成本基于荷兰医疗保险委员会的参考价格和荷兰医疗保健管理局提供的费率。使用线性回归分析来检验医院成本与各种患者及医院特征之间的关联。
共纳入35903例缺血性中风患者和21653例TIA患者。缺血性中风的住院成本为5328欧元（6845美元），TIA的住院成本为2470欧元（3173美元）。缺血性中风的门诊成本为495欧元（636美元），TIA的门诊成本为587欧元（754美元）。颈动脉内膜切除术的成本为6836欧元（8783美元）。住院天数的成本是医院成本的最大贡献因素。年龄、医院类型和地区与医院成本密切相关。
与门诊患者和TIA相比，住院患者和缺血性中风的医院成本更高，住院时间（LOS）是最重要的贡献因素。在过去10年中，LOS和医院成本大幅下降，这可能归因于医院中风护理的改善和高效的综合中风服务。
