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Cost of stroke in Sweden: An incidence estimate

Published online by Cambridge University Press:  01 August 2004

Ola Ghatnekar ,
Ulf Persson ,
Eva-Lotta Glader  and
Andreas Terént
Ola Ghatnekar
Affiliation:
The Swedish Institute for Health Economics
Ulf Persson
Affiliation:
The Swedish Institute for Health Economics
Eva-Lotta Glader
Affiliation:
Umeå University
Andreas Terént
Affiliation:
Uppsala University Hospital
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Abstract

Objectives: To estimate the excess cost of stroke in Sweden and the potential costs that could be avoided by preventing first-ever strokes.

Methods: We adopted the incidence approach for estimating the present value of both direct and indirect costs. Data on mortality, stroke recurrence, and inpatient care were estimated from a national register of patient data with a four-year follow-up period. To estimate costs for social services, we used survey data on living conditions before stroke onset and at three and at twenty-four months. Costs for outpatient visits, rehabilitation, drugs, and production losses due to premature death and early retirement were estimated on the basis of both published and nonpublished sources. Lifetime costs were based on life tables adjusted for excess mortality of stroke, and costs in year 4 were extrapolated to subsequent years.

Results: The present value direct cost for an average stroke patient is SEK513,800 (US$56,024 or Euro60,825). The corresponding indirect cost is SEK125,110 (US$13,640 or Euro14,810). Almost 45 percent of the direct costs were attributable to social services. Women had higher costs than men, and costs for survivors increased with age due to social services.

Conclusions: With an incidence of 213 first-ever strokes per 100,000 individuals, the total excess direct and indirect cost of stroke would be SEK12.3 billion (approximately US$1.3 billion or Euro1.5 billion). Hence, there are large potential cost offsets both in the health-care sector and in the social service sector if the incidence of first-ever stroke could be reduced.

Keywords

StrokeIncidence costCost of illnessSweden
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 3 , August 2004 , pp. 375 - 380
Copyright
© 2004 Cambridge University Press

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References

Asplund K, Hulter Asberg K, Norrving B, Stegmayr B, Terent A. 2003 Riks-stroke: A Swedish national quality register for stroke care. Cerebrovasc Dis. 15 (Suppl 1): 5– 7.Google Scholar
Beech R, Rudd A, Tilling K, Wolfe C. 1999 Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke. 30: 729– 735.Google Scholar
Brouwer W, Rutten F, Koopmanschap M. 2001: Costing in economic evaluations. In: Drummond M, McGuire A, editors. Economic evaluation in health care: Merging theory with practice. Oxford: Oxford University Press 68– 93.
Caro J, Huybrechts K, (for the stroke economic analysis group). 1999 Stroke treatment economic model (STEM): Predicting long-term costs from functional status. Stroke. 30: 2574– 2579.Google Scholar
Centrum för Patientklassificering. 2002 Vårdkostnader och vårdtider 2000 för NordDRG. Socialstyrelsen, Stockholm, Sweden: [Center for Patient Classification, in Swedish].
Claesson L, Gosman-Hedströ G, Johannesson M, Fagerberg B, Blomstrand C. 2000 Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients. Stroke. 31: 2569– 2577.Google Scholar
Dewey H, Thrift A, Mihalopoulos C, et al. 2001 Cost of stroke in Australia from a societal perspective: Results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 32: 2409– 2416.Google Scholar
Evers S, Engel G, Ament A. 1997 Cost of stroke in the Netherlands from a societal perspective. Stroke. 28: 1375– 1381.Google Scholar
Financial Department, Stadsdelsförvaltningen Västra Innerstaden, Malmö, Sweden, 1996. Unpublished.
Glader E-L. Stroke care in Sweden. Hospital care and patient follow-up based on Riks-Stroke, the National Quality Register for Stroke Care.2003, PhD dissertation. Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Gosman-Hedstrom G, Claesson L, Blomstrand C, Fagerberg B, Lundgren-Lindquist B. Use and cost of assistive technology the first year after stroke. A randomized controlled trial. Int J Technol Assess Health Care. 2002 18: 520– 527.Google Scholar
Kaste M, Fogelholm R, Rissanen A. 1998 Economic burden of stroke and the evaluation of new therapies. Public Health. 112: 103– 112.Google Scholar
Kungsholmens stadsdelsnämnd. Bilagor till verksamhetsberättelse med bokslutskommentarer 2000. Stockholm, Sweden [Kungsholmen municipality, Appendices to annual reports 2000, in Swedish].
Linfo, FASS, Kungsbacka, Sweden: Elanders; 2000 [Pharmaceutical Specialities in Sweden, in Swedish].
Medical Index Sweden, 1997 to 2000. Läkemedelsstatistik AB, Stockholm.
Meerding W, Bonneux L, Polder J, Koopmanschap M, van der Maas P. 1998 Demographic and epidemiological determinants of healthcare costs in Netherlands: Cost of illness study. BMJ. 317: 111– 115.Google Scholar
O'Brien J. 2003 Use of diagnosis related groups (DRG) in estimating costs. ISPOR Connect. 9: 5– 7.Google Scholar
Peltonen M, Stegmayr B, Asplund K. 1998 Time trends in long-term survival after stroke: The northern Sweden multinational monitoring of trends and determinants in cardiovascular disease (MONICA) study, 1985-1994. Stroke. 29: 1358– 1365.Google Scholar
Persson U, Silverberg R, Lindgren B, et al. 1990 Direct costs of stroke for a Swedish population. Int J Technol Assess Health Care. 6: 125– 137.Google Scholar
Porsdal V, Boysen G. 1997 Cost of illness studies of stroke. Cerebrovasc Dis. 7: 258– 263.Google Scholar
Riksförsäkringverket. Nybeviljade förtidspensioner/sjukbidrag 1997. Statistikinformation Is-I 1998:008, 1998-04-20, Stockholm, Sweden: Swedish National Social Insurance Board. [In Swedish].
Socialstyrelsen. Att drabbas av stroke—Hur ser situationen ut två år efter insjuknandet? Äldreuppdraget 2000:13, KopieCenter, Stockholm, Sweden: National Board of Health and Welfare. [In Swedish].
Statistics Sweden. 2003. Arbetskraftsundersökningarna 2002 (AKU), AM0401, Örebro, Sweden: Publikationstjänsten [Labour surveys 2002, in Swedish].
Statistics Sweden. 2002 Lönesummor, arbetsgivaravgifter och preliminär A-skatt från skattedeklarationer (LAPS). AM0206, Örebro, Sweden: Publikationstjänsten [Wages, employment pay-roll taxes and preliminary income-taxes from income-tax forms, in Swedish].
Svensson M, Edebalk P-G, Persson U. Gruppboende för åldersdementa—vilken roll spelar utformning, lokalisering och vårdbehov, IHE Arbetsrapport 1995:3, Lund, Sweden. [In Swedish].
Södra Regionvårdsnämnden Regionala Priser och Ersättningar 2000 för Södra Sjukvårdsregionen, 1999 [Southern regional health care board “Prices and Reimbursements for the Southern Health Care Region, 2000, in Swedish].
Taylor T, Davis P, Torner J, et al. 1996 Lifetime cost of stroke in the United States. Stroke. 27: 1459– 1466.Google Scholar
Terént A, Marké LÅ, Asplund K, et al. Costs of stroke in Sweden: A national perspective. Stroke. 1994 25: 2363– 2369.Google Scholar
Thorvaldsen P, Davidsen M, Brønnum-Hansen H, Schroll M, 1999 (for the Danish MONICA study group). Stable stroke occurrence despite incidence reduction in an aging population: Stroke trends in the danish monitoring trends and determinants in cardiovascular disease (MONICA) population. Stroke. 30: 2529– 2534.Google Scholar
Tuomilehto J, Rastenyte D, Sivenius J, et al. 1996 Ten-year trends in stroke incidence and mortality in the FINMONICA Stroke Study. Stroke. 27: 825– 832.Google Scholar
von Koch L, de Pedro-Cuesta J, Kostulas V, Almazán J, Widén-Holmqvist L. Randomized controlled trial of rehabilitation at home after stroke: One-year follow-up of patient outcome, resource use and cost. Cerebrovasc Dis. 2001 12: 131– 138.Google Scholar
Zethraeus N, Molin T, Henriksson P, Jönsson B. Costs of coronary heart disease and stroke: The case of Sweden. J Intern Med. 1999 246: 151– 159.Google Scholar