Heterogeneity in costs and prognosis for acute ischemic stroke treatment by comorbidities
- 120 Downloads
Comorbidities are prevalent among stroke patients. The current study assesses the variations in cost and stroke prognosis by concurrent comorbidities in patients with acute ischemic stroke.
The Charlson comorbidity index was used as the composite comorbidity level (0 none, 1 mild, 2 moderate, and ≥ 3 severe). Outcomes included modified Rankin Scale (mRS) at 3 months and 1-year mortality and stroke recurrence. We utilized a multivariate log-normal model for cost, a proportional Cox hazards model for outcomes, and a decision analytic model for the excess cost per unit change in outcome probability compared with the no-comorbidity group.
A total of 3605 consecutive patients were enrolled. At 3 months, the severe comorbidity group was 0.32 times less likely to have mRS ≤ 2, and were 4.86 times more likely to die from stroke than the no-comorbidity group. Within 1 year, the severe comorbidity group showed 10.36 and 3.38 times higher likelihoods of death from stroke and stroke recurrence than the no-comorbidity group. The incremental cost was 4376 in 3 months and 7074 USD in 1 year for the severe comorbidity group, and 985 in 3 months and 1265 USD in 1 year for the mild comorbidity group compared to the no-comorbidity group.
The excess cost per unit increase of a short-term good prognosis was largest for the severe comorbidity group. Patients with severe comorbidities showed poor prognosis and large health expenditure. Assessing comorbidity level is crucial for better prediction of outcomes and excess cost.
KeywordsComorbidity Excess cost Prognosis Ischemic stroke Heterogeneity
This research was supported by a Grant from the Korea Health Technology Research and Development Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (Grant number: HC15C1056). Research support from the Korea National Research Foundation (Grant number: 2019R1A2C1003259, 2016R1C1B2016028, 2017R1A2B4003373) is also gratefully acknowledged.
Compliance with ethical standards
Conflicts of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The institutional review board of Severance Hospital, Yonsei University Health System, approved this study and waived the patients’ informed consent because of a retrospective design and the observational nature of this study (4-2015-1196).
- 8.Lee AH, Somerford PJ, Yau KK (2003) Factors influencing survival after stroke in Western Australia. Med J Aust 179(6):289–293Google Scholar
- 11.Turhan N, Atalay A, Muderrisoglu H (2009) Predictors of functional outcome in first-ever ischemic stroke: a special interest to ischemic subtypes, comorbidity and age. NeuroRehabilitation 24:321–326Google Scholar
- 12.Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC et al (2016) Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 47(2):581–641CrossRefGoogle Scholar
- 18.Rangaraju S, Frankel M, Jovin TG (2016) Prognostic value of the 24-h neurological examination in anterior circulation ischemic stroke: a post hoc analysis of two randomized controlled stroke trials. Interv Neurol 4(3–4):120–129Google Scholar
- 23.http://kosis.kr/statHtml/statHtml.do?orgId=101&tblId=DT_2KAA602_OECD. Accessed 29 Sept 2018