Euna Han1, Tae Hyun Kim2, Heejo Koo1, Joonsang Yoo3, Ji Hoe Heo3, Hyo Suk Nam4. 1. College of Pharmacy and Yonsei Institute of Pharmaceutical Sciences, Yonsei University, Incheon, South Korea. 2. Graduate School of Public Health and Institute of Health Services Research, Yonsei University, Seoul, South Korea. 3. Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. 4. Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, South Korea. hsnam@yuhs.ac.
Abstract
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
Authors: Sudha Seshadri; Alexa Beiser; Margaret Kelly-Hayes; Carlos S Kase; Rhoda Au; William B Kannel; Philip A Wolf Journal: Stroke Date: 2006-01-05 Impact factor: 7.914
Authors: Verena Schroeder; Elisabeth Ortner; Marie-Luise Mono; Aekaterini Galimanis; Niklaus Meier; Oliver Findling; Urs Fischer; Caspar Brekenfeld; Marcel Arnold; Heinrich P Mattle; Hans P Kohler Journal: Thromb Res Date: 2010-07-01 Impact factor: 3.944
Authors: Kjell Asplund; Juha Karvanen; Simona Giampaoli; Pekka Jousilahti; Matti Niemelä; Grazyna Broda; Giancarlo Cesana; Jean Dallongeville; Pierre Ducimetriere; Alun Evans; Jean Ferrières; Bernadette Haas; Torben Jorgensen; Abdonas Tamosiunas; Diego Vanuzzo; Per-Gunnar Wiklund; John Yarnell; Kari Kuulasmaa; Sangita Kulathinal Journal: Stroke Date: 2009-06-11 Impact factor: 7.914