Abstract
BackgroundPrevious studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke. Patient morbidity is perhaps the least understood of these cost-driving factors. We describe how hypertension and other patient morbidities affect length of stay, and hospital treatment costs after ICH using primary and simulated data. We also describe the relationship between cost and length of stay within these patients.MethodsWe used a cohort design; evaluating 987 consecutive ICH patients across one decade in a Canadian center. Economic, treatment, and patient data were obtained from clinical and administrative sources. Multimorbidity was defined as the presence of one or more diagnoses at hospital admission in addition to a primary diagnosis of ICH.ResultsHypertension was the most frequent (67%) morbidity within these patients, as well as the strongest predictor of longer stay (adjusted RR for >7 days: 1.31, 95% CI: 1.07-1.60), and was significantly associated with higher cost per visit when accounting for other morbidities (adjusted cost increase for hypertension $8123.51, 95% CI: $4088.47 to $12,856.72 USD). A Monte Carlo simulation drawing one million samples of patients estimated for a generation (100 years) assuming 0.94% population growth per year, and a hospitalization rate of 12 per 100,000 inhabitants, supported these findings (p = 0.516 for the difference in unadjusted cost: simulated vs primary). Using a restricted cubic spline, we observed that the rate of change in overall cost for all patients was greatest for the first 3 weeks (p < 0.001) compared to subsequent weeks.ConclusionPatient multimorbidity, specifically hypertension, is a strong predictor of longer stay and cost after ICH. The non-linear relationship between cost and time should also be considered when forecasting healthcare spending in these patients.
Highlights
Previous studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke
Two percent of patients had survived an ICH previous to their current admission, recurrent ICH was not associated with overall cost (p = 0.109)
This study demonstrated that additional morbidities may be associated with longer stay and higher cost of hospital care overall after hemorrhagic stroke; with hypertension being the most frequent and costly multimorbidity
Summary
Previous studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke. We describe how hypertension and other patient morbidities affect length of stay, and hospital treatment costs after ICH using primary and simulated data. Identifying differences in Specogna et al BMC Neurology (2017) 17:158 how specific morbidities are associated with specific costs could reveal differences in care amongst some patients. This cost information could provide insight into ICH care efficiency; both within and beyond emergency departments. The primary purpose of this study was to describe how patient morbidities, hypertension, affect length of stay, and treatment cost after ICH. We describe as a secondary objective, the relationship between cost and length of stay, and explore the potential relationship between stroke severity, clinical outcomes, and cost within these patients
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