David B Matchar1, Marcel Bilger2, Young K Do3, Kirsten Eom2. 1. Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore; Department of Internal Medicine (General Internal Medicine), Duke University Medical Center, Durham, North Carolina. Electronic address: david.matchar@duke-nus.edu.sg. 2. Program in Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore. 3. Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, South Korea; Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, South Korea.
Abstract
BACKGROUND: Long-term costs often represent a large proportion of the total costs induced by stroke, but data on long-term poststroke resource use are sparse, especially regarding the trajectory of costs by severity. We used a multinational longitudinal survey to estimate patterns of poststroke resource use by degree of functional disability and to compare resource use between regions. METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) is a multinational database of adults 50 years and older, which includes demographic information about respondents, age when stroke first occurred, current activity of daily living (ADL) limitations, and health care resource use in the year before interview. We modeled resource use with a 2-part regression for number of hospital days, home nursing hours, and paid and unpaid home caregiving hours. RESULTS: After accounting for time since stroke, number of strokes and comorbidities, age, gender, and European regions, we found that poststroke resource use was strongly associated with ADL limitations. The duration since the stroke event was significantly associated only with inpatient care, and informal help showed significant regional heterogeneity across all ADL limitation levels. CONCLUSIONS: Poststroke physical deficits appear to be a strong driver of long-term resource utilization; treatments that decrease such deficits offer substantial potential for downline cost savings. Analyzing internationally comparable panel data, such as SHARE, provide valuable insight into long-term cost of stroke. More comprehensive international comparisons will require registries with follow-up, particularly for informal and formal home-based care.
BACKGROUND: Long-term costs often represent a large proportion of the total costs induced by stroke, but data on long-term poststroke resource use are sparse, especially regarding the trajectory of costs by severity. We used a multinational longitudinal survey to estimate patterns of poststroke resource use by degree of functional disability and to compare resource use between regions. METHODS: The Survey of Health, Ageing and Retirement in Europe (SHARE) is a multinational database of adults 50 years and older, which includes demographic information about respondents, age when stroke first occurred, current activity of daily living (ADL) limitations, and health care resource use in the year before interview. We modeled resource use with a 2-part regression for number of hospital days, home nursing hours, and paid and unpaid home caregiving hours. RESULTS: After accounting for time since stroke, number of strokes and comorbidities, age, gender, and European regions, we found that poststroke resource use was strongly associated with ADL limitations. The duration since the stroke event was significantly associated only with inpatient care, and informal help showed significant regional heterogeneity across all ADL limitation levels. CONCLUSIONS:Poststroke physical deficits appear to be a strong driver of long-term resource utilization; treatments that decrease such deficits offer substantial potential for downline cost savings. Analyzing internationally comparable panel data, such as SHARE, provide valuable insight into long-term cost of stroke. More comprehensive international comparisons will require registries with follow-up, particularly for informal and formal home-based care.
Authors: Benjamin Hotter; Inken Padberg; Andrea Liebenau; Petra Knispel; Sabine Heel; Diethard Steube; Jörg Wissel; Ian Wellwood; Andreas Meisel Journal: Eur Stroke J Date: 2018-04-19
Authors: Shilpa Tyagi; Gerald Choon-Huat Koh; Luo Nan; Kelvin Bryan Tan; Helen Hoenig; David B Matchar; Joanne Yoong; Eric A Finkelstein; Kim En Lee; N Venketasubramanian; Edward Menon; Kin Ming Chan; Deidre Anne De Silva; Philip Yap; Boon Yeow Tan; Effie Chew; Sherry H Young; Yee Sien Ng; Tian Ming Tu; Yan Hoon Ang; Keng Hee Kong; Rajinder Singh; Reshma A Merchant; Hui Meng Chang; Tseng Tsai Yeo; Chou Ning; Angela Cheong; Yu Li Ng; Chuen Seng Tan Journal: BMC Health Serv Res Date: 2018-11-22 Impact factor: 2.655
Authors: Shilpa Tyagi; Gerald Choon-Huat Koh; Nan Luo; Kelvin Bryan Tan; Helen Hoenig; David B Matchar; Joanne Yoong; Angelique Chan; Kim En Lee; N Venketasubramanian; Edward Menon; Kin Ming Chan; Deidre Anne De Silva; Philip Yap; Boon Yeow Tan; Effie Chew; Sherry H Young; Yee Sien Ng; Tian Ming Tu; Yan Hoon Ang; Keng He Kong; Rajinder Singh; Reshma A Merchant; Hui Meng Chang; Tseng Tsai Yeo; Chou Ning; Angela Cheong; Yu Li Ng; Chuen Seng Tan Journal: BMC Fam Pract Date: 2021-04-14 Impact factor: 2.497