Association Between Disability Measures and Short-term Health Care Costs Following Intracerebral Hemorrhage

Abstract

Small improvements in clinical outcomes after intracerebral hemorrhage (ICH) can have a substantial impact on overall health care costs, yet little data exists on the costs associated with the most commonly studied clinical outcomes in this type of stroke. The Factor Seven for Acute Hemorrhagic Stroke (FAST) trial was a randomized, multicenter, double-blind, placebo-controlled trial conducted between May 2005 and February 2007 at 122 sites in 22 countries. The resource utilization associated with health care services was prospectively recorded in all patients up to day 90 after stroke onset. Measures of disability included the modified Rankin Scale (mRS), and the Barthel Index (BI), while the National Institutes of Health Stroke Scale (NIHSS) measured neurological impairment. Relationships among resource use, health care costs, and disability/impairment were evaluated using one-way ANOVA with Bonferroni testing. A total of 820 patients had complete data. Length of stay (LOS) and total costs varied significantly by mRS scores at 90 days (P < 0.0001). Mean LOS for mRS scores 0-5 and dead were 16, 29, 40, 61, 80, 79, and 14 days, respectively; all categories of mRS had significantly different total LOS from their adjacent categories except mRS 0-1 and mRS 4-5. Mean total costs were $9,500, $15,500, $18,700, $27,400, $27,300, $27,300, and $8,100, respectively; costs rose incrementally up to mRS 3, but were not significantly different for mRS 3, 4, and 5. Total LOS and total costs varied significantly by the Barthel Index scores (P < 0.0001) and NIHSS scores (P < 0.0001), yet significant incremental differences were only observed for the Barthel Index. Health care costs vary significantly by levels of disability as measured by the mRS, but costs do not vary across the full range of mRS outcomes. The mRS is more informative than the Barthel index and NIHSS for discriminating the resource use and costs associated with different levels of disability after ICH.