Soler-Font Mercè, Ribera Aida, Aznar-Lou Ignacio, Sánchez-Viñas Alba, Slof John, Vela Emili, Salvat-Plana Mercè, Villa-García Lorena, Serrano-Blanco Antoni, Pérez de la Osa Natàlia, Ribó Marc, Abilleira Sònia
Health Technology Assessment in Primary Care and Mental Health (PRISMA), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.
Consortium for Biomedical Research in Epidemiology & Public Health (CIBERESP), Madrid, Spain.
Eur Stroke J. 2024 Nov 30:23969873241301904. doi: 10.1177/23969873241301904.
The aim of this study was to estimate societal costs during the first year after stroke by degree of functional disability.
Descriptive study of the cumulative costs incurred during 1-year follow-up of a cohort of patients with stroke in Catalonia (Spain) participating in a multicentre, population-based, cluster-randomised trial (RACECAT). Patients were recruited between September 2017 and January 2019. Costs were collected for each patient from stroke onset to 1-year follow-up through hospital accounting records, electronic healthcare records and structured telephone-based interviews at 6 and 12-months follow-up. Disability was assessed using the 90-day modified Rankin Scale (mRS). Healthcare, community care, and patient/family costs were included. We used complete data from 567 eligible participants. Cost data were analysed using generalised linear models (GLMs) with gamma distributions and log link functions. For variables with >10% zero values, two-part models were applied. We performed sensitivity analyses modifying unit costs for patient/family costs.
Of the 567 patients included, 53% had ischaemic large vessel oclusion (LVO) stroke, 24% intracranial haemorrhage and 23% ischaemic non-LVO stroke. Mean cost per patient during the first year after stroke was €29,673 ± 28,632, and increased with degree of disability (mRS 0-2: €18,568 ± 12,244; mRS 3: €38,214 ± 28,172; mRS 4-5: €52,859 ± 36,383). Healthcare costs represented the highest proportion of total costs (63%; €18,724/patient) across all disability levels, with index hospitalisation being the highest (€12,319 ± 17,675); however, community care and patient/family costs represented over 40% of total cost in patients with higher disability levels.
Our results are in line with other studies; the costs during the first year after stroke are high and increase with disability. These results are valuable for calculating the cost of severe stroke cases.
本研究旨在按功能残疾程度估算卒中后第一年的社会成本。
对西班牙加泰罗尼亚一组参与多中心、基于人群的整群随机试验（RACECAT）的卒中患者进行为期1年随访期间产生的累积成本进行描述性研究。患者于2017年9月至2019年1月招募。通过医院会计记录、电子医疗记录以及在6个月和12个月随访时进行的结构化电话访谈，收集每位患者从卒中发作到1年随访期间的成本。使用90天改良Rankin量表（mRS）评估残疾情况。纳入医疗保健、社区护理以及患者/家庭成本。我们使用了567名符合条件参与者的完整数据。成本数据采用具有伽马分布和对数链接函数的广义线性模型（GLM）进行分析。对于零值超过10%的变量，应用两部分模型。我们对患者/家庭成本的单位成本进行调整后进行了敏感性分析。
在纳入的567例患者中，53%患有缺血性大血管闭塞（LVO）卒中，24%患有颅内出血，23%患有缺血性非LVO卒中。卒中后第一年每位患者的平均成本为29,673欧元±28,632欧元，且随残疾程度增加而增加（mRS 0 - 2：18,568欧元±12,244欧元；mRS 3：38,214欧元±28,172欧元；mRS 4 - 5：52,859欧元±36,383欧元）。在所有残疾水平中，医疗保健成本占总成本的比例最高（63%；每位患者18,724欧元），其中索引住院费用最高（12,319欧元±17,675欧元）；然而，在残疾程度较高的患者中，社区护理和患者/家庭成本占总成本的40%以上。
我们的结果与其他研究一致；卒中后第一年的成本很高，且随残疾程度增加而增加。这些结果对于计算严重卒中病例的成本很有价值。
