The economic burden of stroke care in England, Wales and Northern Ireland: Using a national stroke register to estimate and report patient-level health economic outcomes in stroke

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http://journals.sagepub.com/doi/full/10.1177/2396987317746516?t=1&cn=ZmxleGlibGVfcmVjc18y&refsrc=email&iid=b695a0c89a9c4af2b1a4c26a9a9de32a&fl=4&uid=625967110&nid=244+281088008&

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Xiang-Ming Xu¹

Xiang-Ming Xu

1Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK
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, Emma Vestesson¹

Emma Vestesson

1Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK
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, Lizz Paley¹

Lizz Paley

1Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK
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Anita Desikan²

Anita Desikan

2Division of Health and Social Care Research, 4616King’s College London, London, UK
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, David Wonderling³

David Wonderling

3National Guidelines Centre, 4846Royal College of Physicians, London, UK
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, Alex Hoffman¹

Alex Hoffman

1Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK
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, Charles DA Wolfe²

Charles DA Wolfe

2Division of Health and Social Care Research, 4616King’s College London, London, UK
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, Anthony G Rudd²

Anthony G Rudd

2Division of Health and Social Care Research, 4616King’s College London, London, UK
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, Benjamin D Bray⁴

Benjamin D Bray

4Farr Institute of Health Informatics Research, University College London, London, UK
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on behalf of the SSNAP collaboration

...

First Published November 30, 2017 Research Article

https://doi.org/10.1177/2396987317746516

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Article Information

Article first published online: November 30, 2017
Received: August 25, 2017; Accepted: November 09, 2017

https://doi.org/10.1177/2396987317746516

Xiang-Ming Xu¹, Emma Vestesson¹, Lizz Paley¹, Anita Desikan², David Wonderling³, Alex Hoffman¹, Charles DA Wolfe², Anthony G Rudd², Benjamin D Bray⁴on behalf of the SSNAP collaboration

¹Sentinel Stroke National Audit Programme, Royal College of Physicians, London, UK

²Division of Health and Social Care Research, 4616King’s College London, London, UK

³National Guidelines Centre, 4846Royal College of Physicians, London, UK

⁴Farr Institute of Health Informatics Research, University College London, London, UK

Corresponding Author: Benjamin D Bray, Farr Institute of Health Informatics Research, University College London, 222 Euston Rd, Kings Cross, London NW1 2DA, UK. Email: Benjamin.bray@kcl.ac.uk

This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

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Abstract

Introduction

Stroke registries are used in many settings to measure stroke treatment and outcomes, but rarely include data on health economic outcomes. We aimed to extend the Sentinel Stroke National Audit Programme registry of England, Wales and Northern Ireland to derive and report patient-level estimates of the cost of stroke care.

Methods

An individual patient simulation model was built to estimate health and social care costs at one and five years after stroke, and the cost-benefits of thrombolysis and early supported discharge. Costs were stratified according to age, sex, stroke type (ischaemic or primary intracerebral haemorrhage) and stroke severity. The results were illustrated using data on all patients with stroke included in Sentinel Stroke National Audit Programme from April 2015 to March 2016 (n = 84,184).

Results

The total cost of health and social care for patients with acute stroke each year in England, Wales and Northern Ireland was £3.60 billion in the first five years after admission (mean per patient cost: £46,039). There was fivefold variation in the magnitude of costs between patients, ranging from £19,101 to £107,336. Costs increased with older age, increasing stroke severity and intracerebral hemorrhage stroke. Increasing the proportion of eligible patients receiving thrombolysis or early supported discharge was estimated to save health and social care costs by five years after stroke.

Discussion

The cost of stroke care is large and varies widely between patients. Increasing the proportion of eligible patients receiving thrombolysis or early supported discharge could contribute to reducing the financial burden of stroke.

Conclusion

Extending stroke registers to report individualised data on costs may enhance their potential to support quality improvement and research.