Abstract 208: A Literature Review Of Indirect Cost Of Stroke

Abstract

Background: Stroke is not only a costly deadly disease, but also a leading cause of long-term disability. However, stroke associated indirect costs such as productivity loss and informal care cost have not been well studied. To better develop such studies and provide policy-relevant information, we conducted a literature review of indirect costs of stroke. Methods: We conducted a literature search using PubMed, MEDLINE and EconLit, complemented by Google Scholar search and cross-reference checking using key words of stroke, cerebrovascular disease, subarachnoid hemorrhage, intracerebral hemorrhage, cost of illness, productivity loss, indirect cost, economic burden, and informal caregiving. We identified original research articles published during 1990-2012 in English language peer reviewed journals for the review. Since the number of studies on indirect cost of stroke was small, we included cost-of-illness (COI) studies if they contained sufficient analyses of the indirect cost. We summarized the indirect costs by study type, cost categories, and study settings. Results: There were 31 original research articles investigating the indirect cost of stroke. Only 6 (19%) of these studies solely investigated the indirect cost; the other 25 (81%) studies were COI studies which included the indirect cost as a component. Of the 31 articles, six examined indirect costs in the US. Two of them focused solely on indirect costs. One study at a national level examined informal caregiving among elderly with stroke and estimated the annual cost of such care to be $6.1 billion in 1999. The other study for the State of California estimated lost productivity associated with stroke mortality in the State to be over $1 billion in 1991. The other four US studies suggested that the indirect costs will continue to increase in the coming decades, especially among African American and Hispanics, and that indirect costs might account for over 58% of the total cost of stroke. Due to diverse research methods, data, and cost definitions, the literature suggested a wide range of the indirect cost as a percentage of total stroke costs (2.6% - 71%) often with indirect cost as a significant cost component of stroke. Conclusions: While the literature indicated that the indirect cost accounted for a significant portion of the economic burden of stroke, there is a clear need to develop improved methods to study costs and to better use or establish relevant data sources for such studies. With the aging population and increasing survival rate of stroke, both direct and indirect costs of stroke are likely to increase greatly. Interventions for stroke prevention as well as for improving quality of life among stroke patients are needed to contain both direct and indirect costs associated with stroke. More research investigating the indirect costs will be helpful in guiding the development of such interventions to reduce the burden of stroke.