A Population-Based Study of Hospital Care Costs During 5 Years After Transient Ischemic Attack and Stroke
ABSTRACT BACKGROUND AND PURPOSE: Few studies have evaluated long-term costs after stroke onset, with almost no cost data for transient ischemic attack (TIA). We studied hospital costs during the 5 years after TIA or stroke in a population-based study. METHODS: Patients from a United Kingdom population-based cohort study (Oxford Vascular Study) were recruited from 2002 to 2007. Analysis was based on follow-up until 2010. Hospital resource usage was obtained from patient hospital records and valued using 2008/2009 unit costs. Because not all patients had full 5-year follow-up, we used nonparametric censoring techniques. RESULTS: Among 485 TIA and 729 stroke patients ascertained and included, mean censor-adjusted 5-year hospital costs after index stroke were $25 741 (95% confidence interval, 23 659-27 914), with costs varying considerably by severity: $21 134 after minor stroke; $33 119 after moderate stroke; and $28 552 after severe stroke. For the 239 surviving stroke patients who had reached final follow-up, mean costs were $24 383 (95% confidence interval, 20 156-28 595), with more than half of costs ($12 972) being incurred in the first year after the event. After index TIA, the mean censor-adjusted 5-year costs were $18 091 (95% confidence interval, 15 947-20 258). A multivariate analysis showed that event severity, recurrent stroke, and coronary events after the index event were independent predictors of 5-year costs. Differences by stroke subtype were mostly explained by stroke severity and subsequent events. CONCLUSIONS: Long-term hospital costs after TIA and stroke are considerable, but they are mainly incurred during the first year after the index event. Event severity and experiencing subsequent stroke and coronary events after the index event accounted for much of the increase in costs.
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ABSTRACT: BACKGROUND AND PURPOSE: Approximately 70% of all patients presenting with transient ischemic attack are admitted to the hospital in United States. The duration and cost of hospitalization and associated factors are poorly understood. This article seeks to identify the proportion and determinants of prolonged hospitalization and to determine the impact on hospital charges using nationally representative data. METHODS: We determined the national estimates of length of stay, mortality, and charges incurred in patients admitted with transient ischemic attack (diagnosis-related code 524 or 069) using Nationwide Inpatient Sample data from 2002 to 2010. Nationwide Inpatient Sample is the largest all-payer inpatient care database in the United States and contains data from ≈1000 hospitals, which is a 20% stratified sample of US community hospitals. All the variables pertaining to hospitalization were compared in 3 groups on the basis of length of hospital stay (≤1, 2-6, and ≥7 days). RESULTS: A total of 949 558 patients were admitted with the diagnosis of transient ischemic attack during the study period. The length of hospitalization was ≤1, 2 to 6, and ≥7 days in 232 732 (24.4%), 662 909 (70%), and 53 917 (5.6%) patients, respectively. The mean hospitalization charges were $10876, $17 187, and $38 200 for patients hospitalized for ≤1, 2 to 6, and ≥7 days, respectively. The use of thrombolytics (0.03%, 0.09%, and 0.1%; P<0.0001) for ischemic stroke was very low among the 3 strata defined by length of hospitalization. In the multivariate analysis, the following factors were associated with length of hospitalization of ≥2 days: age >65 years (odds ratio [OR], 1.5), women (OR, 1.2), admission to teaching hospitals (OR, 1.1), renal failure (OR, 1.7), hypertension (OR, 1.1), diabetes mellitus (OR, 1.2), chronic lung disease (OR, 1.4), congestive heart failure (OR, 1.4), atrial fibrillation (OR, 1.5), ischemic stroke occurrence (OR, 1.4), Medicare/Medicaid insurance (OR, 1.3), and hospital location in Northeast US region (OR, 1.5; all P values <0.025). CONCLUSIONS: Approximately 75% of patients admitted with transient ischemic attack stay in the hospital for ≥2 days, with the most important determinants being pre-existing medical comorbidities. Longer duration of hospital stay is associated with 2- to 5-fold greater hospitalization charges.Stroke 04/2013; 44(6). DOI:10.1161/STROKEAHA.111.000590 · 6.02 Impact Factor
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ABSTRACT: The 2010 American Academy of Neurology guideline for the diagnosis of acute ischemic stroke recommends MRI with diffusion weighted imaging (DWI) over noncontrast head CT. No studies have evaluated the influence of imaging choice on patient outcome. We sought to evaluate the variables that influenced one-year outcomes of stroke and TIA patients, including the type of imaging utilized. Patients were identified from a prospectively collected stroke and TIA database at a single primary stroke center during a one-year period. Data were abstracted from patient electronic medical records. The primary outcome measure was death, myocardial infarction, or recurrent stroke within the following year. Secondary outcome measures included predictors of getting an MRI study. 727 consecutive patients with a discharge diagnosis of stroke or TIA were identified (616 and 111 respectively); 536 had CT and MRI, 161 had CT alone, 29 had MRI alone, and one had no neuroimaging. On multiple logistic regression analysis, there were no differences in primary or secondary outcome measures among different imaging strategies. Predictors of the primary outcome measure included age and NIHSS, while performance of a CT angiogram (CTA) predicted a decreased odds of death, stroke, or MI. The strongest predictor of having an MRI was admission to a stroke unit. These results suggest that long-term (one-year) patient outcomes may not be influenced by imaging strategy. Performance of a CTA was protective in this cohort. A randomized trial of different imaging modalities should be considered.The Open Neurology Journal 05/2013; 7(1):17-22. DOI:10.2174/1874205X01307010017
- Neurosurgery 05/2013; DOI:10.1227/01.neu.0000431482.32902.99 · 3.03 Impact Factor