Analysis of in-hospital resource use after an ischemic stroke

Authors: Dewilde S, Annemans L, Thijs V
Published in: Value in Health. 2015 Nov;18(7):A388

Abstract

Objectives: To investigate the resources used by ischemic stroke patients when hospitalized, and examine this relationship by stroke severity. Comparing a bottom-up costing approach with national top-down costs.

Methods: Data from five Belgian hospitals were requested for the years 2008 up to 2011 detailing the length-of-stay (LOS), drugs, medical imaging and clinical biology tests. Participating hospitals were distributed across the country and included regional as well as teaching hospitals. Severity of the stroke was defined as mild, moderate, major or severe according to the Severity-of-Illness (SOI) categorization within APR-DRG category 045, which is determined by the classification of primary and secondary diagnoses. Average bottom-up costs were compared to the national reimbursement received by hospitals.

Results: 2,496 hospital admissions were included in our analysis; all admissions contributed to the LOS calculations, 2,364 observations were available for medical imaging, 1,954 for drug treatments whereas data for clinical biology were very scarce. Patients were distributed across SOI categories as follows: 3.9% mild, 51.8% moderate, 26.4% major, 17.9% severe with LOS 5.61, 10.78, 19.43 and 34.60 days respectively. Costs for drugs ranged from €139.82 in SOI1, €150.26 in SOI2, €349.51 in SOI3 and €758.41 in SOI4. Data on clinical biology amounted to €17.13 per patient; on average 15 types of lab tests were used. Costs for imaging also varied by severity and were €876.58, €866.29, €930.07 and €1,247.45 for increasing levels of SOI. In total 39 different imaging tests were used covering among others functional measurements, radiology, Rx, CT and MRI. Total costs amounted to €3,653 , €5,583 , €9,489 , €16,660 respectively. Compared to the national average these costs are 5% lower, mainly due to underestimation of honoraria.

Conclusions: In-hospital costs increase with stroke severity, with the most severe patients costing 4.5 times more than mild patients. Bottom-up costing approximated the top-down costs.