The economic and health burden of stroke among younger adults in Australia from a societal perspective

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The economic and health burden of stroke among younger adults in Australia from a societal perspective

• Elise Tan,
• Lan Gao,
• Janice M. Collier,
• Fiona Ellery,
• Helen M. Dewey,
• Julie Bernhardt,
• The AVERT Trial Collaboration Group &
• Marj Moodie 

BMC Public Health volume 22, Article number: 218 (2022) Cite this article

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Abstract

Background

To estimate the short term (5 years) and long term (30 years) economic burden of stroke among younger adults (18–64 years), and to calculate the loss of health-related quality of life in these individuals, in Australia.

Methods

A Markov microsimulation model was built to simulate incidence of stroke among younger adults in Australia. Younger adults with stroke commenced in the model via health states defined by the modified Rankin Scale at 12 months from the AVERT study (A Very Early Rehabilitation Trial), and transitioned through these health states. Costs in Australian dollars (AUD) were measured from a societal perspective for a 2018 reference year and categorised into medical, non-medical and indirect costs. Probabilistic sensitivity analyses were performed to test the robustness around the cost of illness estimates. The loss of health-related quality of life due to stroke among younger adults was calculated by determining the difference in estimated quality-adjusted life years (QALYs) between the stroke population and the general population. This was determined by multiplying the predicted remaining life years for the modelled stroke cohort and the age-matched general population, by their corresponding age-dependent utilities.

Results

The economic burden of stroke among younger adults was estimated to be AUD2.0 billion over 5 years, corresponding to a mean of $149,180 per stroke patient. Over 30 years, the economic impact was AUD3.4 billion, equating to a mean of $249,780 per case. Probabilistic sensitivity analyses revealed a mean cost per patient of $153,410 in the short term, and a mean cost per patient of $273,496 in the long term. Compared to the age-matched general population, younger adults with stroke experienced a loss of 4.58 life years and 9.21 QALYs.

Conclusions

The results of our study suggests high economic and health burden of stroke among younger adults and highlights the need for preventive interventions targeting this age group.

Trial registration

ACTRN12606000185561, retrospectively registered.

Peer Review reports

Background

Stroke is a leading cause of death and disability in Australia and worldwide [1]. It is often thought of as an older person’s disease – but people of any age can suffer a stroke. Approximately 25% of first-ever strokes in adults occur in those under the age of 65 [2]. Though people of working age represent a small proportion of total stroke patients, they carry a disproportionately larger share of the resultant economic burden [3].

Some 65% of stroke survivors live with debilitating effects and experience reduced quality of life, resulting in significant costs and productivity losses [4]. In Australia, approximately 30% of stroke survivors are aged under 65 years, equating to an estimated 149,000 people in 2018 [4, 5]. As younger survivors live with the health consequences of stroke for longer, and stroke related costs are sustained over an extended period, the associated economic and health burden is distinct from that of stroke in the elderly.

Several Australian studies have investigated the economic impact of stroke, however, none were specific to persons of working age. The total lifetime cost of stroke in Australia was estimated as Australian dollars (AUD) 3.1 billion in 2010 (US dollars (USD) 2.1 billion), corresponding to a total cost per case of AUD99,938 [6]. A Very Early Rehabilitation Trial (AVERT) provides recent comprehensive resource use information relating to the 12 months following a stroke, and an opportunity to estimate the impact of stroke among younger adults (18–64 years) in Australia. Participants were included in this trial as being disabled post stroke and being able to benefit from rehabilitation. This examination is of interest to policy makers and consumer groups alike, by informing future policy decisions, resource allocation and priority setting for stroke. Using modelling of data, the aim of this paper is to determine 1) the economic (medical, non-medical and indirect) costs of stroke among younger adults (18–64 years); and 2) the associated loss of health-related quality of life.