Editors' Note: Three-Month Modified Rankin Scale as a Determinant of 5-Year Cumulative Costs After Ischemic Stroke: An Analysis of 11,136 Patients in Korea

Abstract

Using their pooled, prospective multicenter registry of over 11,000 Korean stroke survivors, Dr. Kim et al. reported the estimated direct healthcare costs in the years after acute ischemic stroke. Unsurprisingly, the estimated direct costs of care (including costs of inpatient and outpatient visits, prescription medications, and long-term care) were significantly greater in the year after stroke than the year before (mean $38,152 USD vs $8,718 USD), with a 5-year cumulative poststroke cost estimated at $117,576 USD. Importantly, there was considerable variation in the 5-year cumulative healthcare costs based on 3-month disability using the modified Rankin Scale (mRS). Compared with patients with no disability (mRS 0), patients dependent on others for ambulation and for activities of daily living (mRS 4) incurred considerably greater costs over the same period ($279,188 vs $53,578). Because healthcare administrators and policy makers determine healthcare reimbursement rates for various conditions and treatments, it is critical that any independent benefit of acute stroke intervention (e.g., reperfusion therapies) be evaluated thoroughly—as pointed out by Drs. Ganesh and Varma. In this analysis, recanalization therapies were strongly associated with better 3-month functional outcomes but paradoxically increased inpatient and outpatient care costs in the final multivariable model. It seems that the long-term functional disability (3-month mRS) was the principal driver of the cost effect, and after adjustment for this variable, any cost savings from recanalization could be negated. To clarify whether (and to what degree) acute recanalization therapies may mediate the long-term cost savings in stroke survivors, the investigators are exploring ways to model this in a follow-up analysis. Using their pooled, prospective multicenter registry of over 11,000 Korean stroke survivors, Dr. Kim et al. reported the estimated direct healthcare costs in the years after acute ischemic stroke. Unsurprisingly, the estimated direct costs of care (including costs of inpatient and outpatient visits, prescription medications, and long-term care) were significantly greater in the year after stroke than the year before (mean $38,152 USD vs $8,718 USD), with a 5-year cumulative poststroke cost estimated at $117,576 USD. Importantly, there was considerable variation in the 5-year cumulative healthcare costs based on 3-month disability using the modified Rankin Scale (mRS). Compared with patients with no disability (mRS 0), patients dependent on others for ambulation and for activities of daily living (mRS 4) incurred considerably greater costs over the same period ($279,188 vs $53,578). Because healthcare administrators and policy makers determine healthcare reimbursement rates for various conditions and treatments, it is critical that any independent benefit of acute stroke intervention (e.g., reperfusion therapies) be evaluated thoroughly—as pointed out by Drs. Ganesh and Varma. In this analysis, recanalization therapies were strongly associated with better 3-month functional outcomes but paradoxically increased inpatient and outpatient care costs in the final multivariable model. It seems that the long-term functional disability (3-month mRS) was the principal driver of the cost effect, and after adjustment for this variable, any cost savings from recanalization could be negated. To clarify whether (and to what degree) acute recanalization therapies may mediate the long-term cost savings in stroke survivors, the investigators are exploring ways to model this in a follow-up analysis.