Yousufuddin Mohammed, Moriarty James P, Lackore Kandace A, Zhu Ye, Peters Jessica L, Doyle Taylor, Jensen Kelsey L, Ahmmad Eimad M, Al Ward Ruaa Y, Al-Zu'bi Hossam M, Sharma Umesh M, Seshadri Ashok, Arumaithurai Kogulavadanan, Keenan Lawrence R, Bhagra Sumit, Murad Mohammad Hassan, Borah Bijan J
Department of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA.
Economic Evaluation Unit, Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA; Division of Healthcare Policy and Research, Mayo Clinic, Rochester, MN, USA.
J Neurol Sci. 2020 Dec 15;419:117181. doi: 10.1016/j.jns.2020.117181. Epub 2020 Oct 18.
To examine 1) the major drivers of index hospitalization and 3-year post-acute follow-up care, 2) cost for rehabilitation and homecare, and 3) indirect cost from lost productivity after acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH).
Retrospective study of adults hospitalized with AIS (n = 811) and ICH (N = 145) between 2003 and 2014. Direct costs standardized to Medicare reimbursement rates were captured for hospitalization and 3-year follow-up or death. Adjusted cost estimates were assessed using generalized linear modeling with gamma distribution. Costs for rehabilitation, home healthcare, and lost productivity were assessed using sets of cost captured through literature review.
Calculated as mean cost per person: hospitalization $18,154 for AIS and $24,077 for ICH; monthly 3-year aggregate $5138 for AIS and $8172 for ICH; 3-year inpatient rehabilitation $4185 for AIS and $4196 for ICH; homecare $19,728 for AIS and $14,487 for ICH; indirect cost from lost productivity $77,078 for AIS and $56,601 for ICH. Age < 55 years, being non-white, and stroke severity were strongly associated with greater hospitalization cost for AIS and ICH. Hyperlipidemia incurred lower while cancer, coronary artery disease, asthma/chronic obstructive pulmonary disease, heart failure, and anemia incurred higher 3-year aggregate cost for AIS. Cancer and diabetes mellitus incurred higher 3-year aggregate cost for ICH.
We provide estimates of direct and indirect costs incurred for acute and continuing post-acute care through a 3-year follow-up period after first-ever AIS and ICH with important comparisons for predictors between index hospitalization and 3-year post-stroke costs.
研究1）首次缺血性脑卒中（AIS）和脑出血（ICH）后指数住院治疗及3年急性后期随访护理的主要驱动因素，2）康复和家庭护理费用，以及3）急性缺血性脑卒中和脑出血后生产力损失的间接成本。
对2003年至2014年间因AIS（n = 811）和ICH（N = 145）住院的成人进行回顾性研究。根据医疗保险报销率标准化的直接成本用于住院治疗和3年随访或死亡。使用具有伽马分布的广义线性模型评估调整后的成本估计值。通过文献综述收集的成本集评估康复、家庭医疗保健和生产力损失的成本。
按人均平均成本计算：AIS住院费用为18,154美元，ICH为24,077美元；3年总计每月AIS为5138美元，ICH为8172美元；3年住院康复AIS为4185美元，ICH为4196美元；家庭护理AIS为19,728美元，ICH为14,487美元；AIS生产力损失间接成本为77,078美元，ICH为56,601美元。年龄<55岁、非白人以及中风严重程度与AIS和ICH的住院费用增加密切相关。高脂血症导致的3年总计成本较低，而癌症、冠状动脉疾病、哮喘/慢性阻塞性肺疾病、心力衰竭和贫血导致AIS的3年总计成本较高。癌症和糖尿病导致ICH的3年总计成本较高。
我们通过对首次AIS和ICH后的3年随访期，提供了急性和持续急性后期护理的直接和间接成本估计，并对指数住院和中风后3年成本之间的预测因素进行了重要比较。
