The cost of stroke in private hospitals in Brazil: a one-year prospective study.

Luana Gabriela Dalla Rosa Vieira,Tainá De Araujo,Norberto Luiz Cabral,Suleimy Mazin,Vivian Nagel,Maria Helena Ribeiro Kuhlhoff,Gisele Sampaio Silva,Adriana Bastos Conforto,Helen Aparecida Schuch,Juliana Safanelli

doi:10.1590/0004-282x20190056

Abstract

Few studies from low- and middle-income countries have assessed stroke and cerebral reperfusion costs from the private sector. To measure the in-hospital costs of ischemic stroke (IS), with and without cerebral reperfusion, primary intracerebral hemorrhage (PIH), subarachnoid hemorrhage (SAH) and transient ischemic attacks (TIA) in two private hospitals in Joinville, Brazil. Prospective disease-cost study. All medical and nonmedical costs for patients admitted with any stroke type or TIA were consecutively determined in 2016-17. All costs were adjusted to the gross domestic product deflator index and purchasing power parity. We included 173 patients. The median cost per patient was US$3,827 (IQR: 2,800-8,664) for the 131 IS patients; US$2,315 (IQR: 1,692-2,959) for the 27 TIA patients; US$16,442 (IQR: 5,108-33,355) for the 11 PIH patients and US$28,928 (IQR: 12,424-48,037) for the four SAH patients (p < 0.00001). For the six IS patients who underwent intravenous thrombolysis, the median cost per patient was US$11,463 (IQR: 8,931-14,291), and for the four IS patients who underwent intra-arterial thrombectomy, the median cost per patient was US$35,092 (IQR: 31,833-37,626; p < 0.0001). A direct correlation was found between cost and length of stay (r = 0.67, p < 0.001). Stroke is a costly disease. In the private sector, the costs of cerebral reperfusion for IS treatment were three-to-ten times higher than for usual treatments. Therefore, cost-effectiveness studies are urgently needed in low- and middle-income countries.

Highlights

Few studies from low- and middle-income countries have assessed stroke and cerebral reperfusion costs from the private sector
A total of 173 patients were included in the study, of whom 76% (131/173) were diagnosed with ischemic stroke (IS), 6% (11/173) with primary intracerebral hemorrhage (PIH), 2% (4/173) with subarachnoid hemorrhage (SAH) and 16% (27/173) with a transient ischemic attacks (TIA)
More than one-third of all medical and nonmedical costs were incurred by two items. This prospective study in a middle-income country showed that the overall in-hospital cost of 173 strokes during 2016-17 was approximately United States dollars (US$)1.8 million

Summary

Introduction

Few studies from low- and middle-income countries have assessed stroke and cerebral reperfusion costs from the private sector. Objective: To measure the in-hospital costs of ischemic stroke (IS), with and without cerebral reperfusion, primary intracerebral hemorrhage (PIH), subarachnoid hemorrhage (SAH) and transient ischemic attacks (TIA) in two private hospitals in Joinville, Brazil. RESUMO Poucos estudos determinam o custo do AVC em países de baixa e média renda nos setores privados. Objetivos: Mensurar o custo hospitalar do tratamento do(a): AVC isquêmico com e sem reperfusão cerebral, hemorragia intracerebral primária (HIP), hemorragia subaracnóidea e ataque isquêmico transitório (AIT) em hospitais privados de Joinville, Brasil. Os custos da reperfusão cerebral foram de três a dez vezes superiores aos tratamentos habituais do AVC isquêmico.

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