Abstract
BackgroundThe economic burden of stroke on the healthcare system has been previously described, but sex differences in healthcare costs have not been well characterized. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke.MethodsIn this population-based cohort study of patients admitted to hospital with stroke between 2008 and 2017 in Ontario, Canada, we used linked administrative data to calculate direct person-level costs in Canadian dollars in the one-year following stroke. We used a generalized linear model with a gamma distribution and a log link function to compare costs in women and men with and without adjustment for baseline clinical differences. We also assessed for an interaction between age and sex using restricted cubic splines to model the association of age with costs.ResultsWe identified 101,252 patients (49% were women, median age [Q1-Q3] was 76 years [65–84]). Unadjusted costs following stroke were higher in women compared to men (mean ± standard deviation cost was $54,012 ± 54,766 for women versus $52,829 ± 59,955 for men, and median cost was $36,703 [$16,496–$72,227] for women versus $32,903 [$15,485–$66,007] for men). However, after adjustment, women had 3% lower costs compared to men (relative cost ratio and 95% confidence interval 0.97 [0.96,0.98]). The lower cost in women compared to men was most prominent among people aged over 85 years (p for interaction = 0.03). Women incurred lower costs than men in outpatient care and rehabilitation, but higher costs in complex continuing care, long-term care, and home care.ConclusionsPatterns of resource utilization and direct medical costs were different between men and women after stroke. Our findings inform public payers of the drivers of costs following stroke and suggest the need for sex-based cost-effectiveness evaluation of stroke interventions with consideration of costs in all care settings.
Highlights
Stroke is a leading cause of disability globally
We described the direct healthcare cost in men and women as well as the healthcare settings in which these costs were incurred in the year after a hospitalization for stroke in Ontario, Canada with and without adjustment for comorbidities and costs incurred in the year prior to stroke
Women tended to be older than men at the time of stroke, were more likely to have comorbid hypertension, atrial fibrillation, and to have higher frailty and stroke severity scores; while men were more likely to have coronary artery disease, diabetes, and peripheral artery disease than women
Summary
Stroke is a leading cause of disability globally. In addition to affecting the lives of patients and their caregivers, stroke imposes a significant economic burden on the healthcare system [1, 2]. Poor functional outcome is associated with higher healthcare costs, [5] but sex differences in stroke-related healthcare costs are not well understood. This information is important for several reasons. Evaluating the settings in which the costs are incurred, whether they are in acute care, rehabilitation, outpatient services, or elsewhere, provides information on whether the drivers of costs are different for women and men. This knowledge may help avoid the implementation of focused efforts to reduce cost in one setting (e.g. acute care) only to have these costs shifted to another setting (e.g. nursing homes) without any overall gain [8]. We described the direct person-level healthcare cost in men and women as well as the various health settings in which costs were incurred following stroke
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
