Abstract
ObjectivesMost stroke care expenses are inhospital costs. Given the previously reported inaccuracy of conventional costing, the purpose of this study was to provide an accurate analysis of inpatient costs of stroke care in an acute care hospital. Materials and methodsWe used activity-based costing (ABC) for calculating the costs of ischemic stroke patients. We collected the activity data at the Helsinki University Central Hospital. Persons involved in patient care logged their activities on survey forms for one week. The costs of activities were calculated based on information about salaries, material prices, and other costs obtained from hospital accounting data. We calculated costs per inpatient days and episodes, analyzed cost structure, made a distinction in cost for stroke subtypes according to the Oxford and TOAST classification schemes, and compared cost per inpatient episode with the diagnoses-related group (DRG) -price of the hospital. ResultsThe sample comprised 196 inpatient days of 41 patients. By using the ABC, the mean and median costs of an inpatient day were 346 € and 268 €, and of an inpatient episode 3322 € and 2573 €, respectively. Average costs differed considerably by stroke subtype. The first inpatient day was the most expensive. Working time costs comprised 63% of the average inpatient day cost, with nursing constituting the largest proportion. The mean cost of an inpatient episode was 21% lower with ABC than with DRG pricing. ConclusionWe demonstrate that there are differences in cost estimates depending on the methods used. ABC revealed differences among patients having the same diagnosis. The cost of an episode was lower than the DRG price of the hospital. Choosing an optimal costing method is essential for both reimbursements of hospitals and health policy decision-making.
Highlights
The stroke burden continues to increase [1]
The mean cost of an inpatient episode was 21% lower than the price (4230 €) of the NordDRG group 014, which includes the ischemic stroke
The stroke unit has the smallest difference between the activity-based costing (ABC)- calculated cost of the care episode and the diagnosis-related groups (DRG) price
Summary
The stroke burden continues to increase [1]. In Finland, the mean one-year costs after an ischemic stroke are approximately 21 300 €, and the average stroke-related lifetime healthcare costs 60 000 €. The sum annually spent in the treatment of stroke patients in Finland is 7% of total healthcare costs, and stroke is one of the most significant causes of hospitalization [2, 3, 4, 5, 6]. Total hospital costs have been calculated based on the sum of the values of inpatient days and outpatient visits. Its objective is to relate patients to the resources needed to treat them [12, 13], and DRG cost calculations are based on average resource consumption per diagnosis group. The values of diagnostic and therapeutic procedures, as well as expensive drugs, are specified by category, but nursing care, typically representing about 50% of the total costs, is handled as a unit overhead, equal for all inpatients [12]
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