Smeds Marika, Skrifvars Markus B, Reinikainen Matti, Bendel Stepani, Hoppu Sanna, Laitio Ruut, Ala-Kokko Tero, Curtze Sami, Sibolt Gerli, Martinez-Majander Nicolas, Raj Rahul
Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
Eur Stroke J. 2022 Sep;7(3):267-279. doi: 10.1177/23969873221094705. Epub 2022 Apr 29.
Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking.
Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs.
Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs.
Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.
自发性脑出血（ICH）具有较高的死亡率和发病率。重症脑出血患者在重症监护病房（ICU）接受治疗，但缺乏关于1年医疗费用和患者护理成本效益的数据。
对2003年至2013年接受自发性脑出血治疗的959例成年患者进行回顾性多中心研究。主要结局为12个月死亡率或永久性残疾，定义为到2016年获得社会保险机构发放的永久性残疾津贴或抚恤金。总医疗费用包括12个月内的医院费用、康复费用和社会保障费用。对经对数转换的成本数据进行多变量线性回归，并对病例组合进行调整，以评估与成本相关的独立因素。
12个月死亡率为45%，51%的幸存者在随访结束时残疾。12个月的平均总成本为49,754欧元，其中康复费用、三级医院费用和社会保障费用分别占45%、39%和16%。在年龄>70岁、患有脑干ICH、格拉斯哥昏迷量表（GCS）评分低、血肿体积大、脑室内出血且ICH评分为3的患者中，每独立存活者的最高有效成本（ECPIS）被记录到。在多变量分析中，年龄、GCS评分和疾病严重程度与1年医疗费用独立相关。
ICH相关成本在不同患者群体之间存在差异，ECPIS在70岁以上患者以及患有脑干ICH和较高ICH评分的患者中似乎最高。三分之一的财政资源用于预后良好的患者。需要对ICH患者进行进一步详细的成本分析研究。
