PND18 Treatment Cost of Ischemic Stroke Inpatient Admissions in Romanian Public Hospitals

Abstract

The objective of this study was to analyze direct medical costs associated with acute ischemic stroke (AIS) inpatient admissions in Romanian public hospitals. We performed a retrospective cost analysis of tertiary expenditure from AIS cases in 2018. Anonymized cost information was extracted from controlling systems of 8 representative hospitals selected based on medical, demographic, and geographic criteria. Key stakeholder consultations determined ICD-10 entries used to code AIS in Romania. Costs related to medical services, staff salaries, and overhead were measured for all patients admitted with a primary or secondary diagnosis of AIS. Sample representativity was calculated using aggregated, country-wide discharge data collected from the Romanian National School of Public Health. Costs were converted into 2020 Euros using the CCEMG – EPPI-Centre Cost Converter. 76% of patients were hospitalized once (mean per patient = 1.36 admissions). More than half of all cases were initially admitted to neurology, and subsequently referred to internal medicine, cardiology, or rehabilitation wards. Our cost analysis covered over 11% percent of all cases at national level. Stroke-related inpatient admissions in Romanian public hospitals costed on average €820 (median = €674) in 2018. The average inpatient day hospital cost was €124. Neurosurgery (mean = €2034), rehabilitation (mean = €1048), and neurology (mean = €902) were the most expensive wards. Total direct medical expenditure at national level was estimated at 190 million Euros (€9.7 per capita). Index strokes could not be identified based on existing data. Stroke-related medical costs are lower in Romania, as compared to other European countries. Moreover, access to post-stroke rehabilitation is very poor. Non-medical costs should be considered as part of a broader perspective cost of illness study. International estimates and extrapolations regarding epidemiology and economic burden of stroke in Romania are inaccurate, overlooking chronic health system underfunding, which in turn influences patient pathways.