Abstract
Background: Health policies in transitioning health systems are rarely informed by the economic burden of disease due to scanty access to data. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Methods: The study was conducted using a mixed, retrospective costing methodology from a societal perspective to measure the cost of first-ever AIS in the first year after onset. Patient pathways for AIS were reconstructed to aid in mapping inpatient and outpatient cost items. We used anonymized administrative and clinical data at the hospital level and publicly available databases. Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs. The total cost in Cluj, Romania in 2019 was RON 17,455,502.7 (EUR 3,606,505.8). Conclusions: Our costing exercise uncovered shortcomings of stroke management in Romania, particularly related to acute care and neurorehabilitation service provision. Romania spends significantly less on healthcare than other countries (5.5% of GDP vs. 9.8% European Union average), exposing stroke survivors to a disproportionately high risk for preventable and treatable post-stroke disability.
Highlights
Based on the latest WHO projections, stroke will continue to be a severe challenge to population health, as it is expected to maintain its leading position as a global cause of mortality until 2060 [1]
We employed a mixed methodology (bottom-up [20], using the costs generated by acute ischemic stroke patients within the Cluj County Emergency Hospital (CEH); and top-down [20], which takes budgets allocated to CEH for specific procedures such as thrombolysis, and other public data on chronic care from the framework contract, on pensions and informal care [11,21,22])
Our analysis identified 690 first-ever acute ischemic stroke (AIS) patients discharged alive from inpatient care on CEH neurology wards in 2019, of which 67.39% of patients were coded with I63.3 and
Summary
Based on the latest WHO projections, stroke will continue to be a severe challenge to population health, as it is expected to maintain its leading position as a global cause of mortality until 2060 [1]. Out of the three main stroke categories, ischemic stroke is the most prevalent [8,9,10]. Procedures such as intravenous thrombolysis and mechanical thrombectomy have been used in stroke-like units in Romania to improve post-stroke outcomes for eligible patients [11], decreasing costs [12,13]. This study aimed to estimate direct and indirect costs for first-ever acute ischemic stroke (AIS) during the first year for patients residing in Cluj, Romania, and hospitalized in 2019 at the County Emergency Hospital (CEH). Results: The average cost per patient in the first year after stroke onset was RON 25,297.83 (EUR 5226.82), out of which 80.87% were direct costs
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