One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

Marika Smeds; Markus B. Skrifvars; Matti Reinikainen; Stepani Bendel; Sanna Hoppu; Ruut Laitio; Tero Ala-Kokko; Sami Curtze; Gerli Sibolt; Nicolas Martinez-Majander; Rahul Raj

doi:10.1177/23969873221094705

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

Marika Smeds
, Markus B. Skrifvars
, Matti Reinikainen
, Stepani Bendel
, Sanna Hoppu
, Ruut Laitio
, Tero Ala-Kokko
, Sami Curtze
, Gerli Sibolt
, Nicolas Martinez-Majander
, Rahul Raj^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Scientific › peer-review

5 Citations (Scopus)

24 Downloads (Pure)

Abstract

Background: Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking. Methods: Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs. Results: Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs. Conclusions: Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

Original language	English
Number of pages	13
Journal	European Stroke Journal
Volume	7
Issue number	3
DOIs	https://doi.org/10.1177/23969873221094705
Publication status	Published - 2022
Publication type	A1 Journal article-refereed

Funding

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare the following conflicts of interest: Dr. Smeds reports independent research grants from Finska Läkaresällskapet (the Finnish Medical Association) and Suomen Lääketieteen Säätiö (the Finnish Medical Foundation) during the conduct of the study. Dr. Raj reports personal research grants from Finska Läkaresällskapet (the Finnish Medical Association) and Medicinska Understödsföreningen Liv & Hälsa (the Medical Support Foundation Life & Health). Professor Markus Skrifvars reports speaker fees and travel grants from BARD Medical (Ireland). The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from Finska Läkaresällskapet, Suomen Lääketieteen Säätiö, Medicinska Understödsföreningen Liv och Hälsa, and a three-year project grant from University of Helsinki (H3702, WBS 73702705). MS received a personal research grant from Finska Läkaresällskapet (the Finnish Medical Association) and Suomen Lääketieteen Säätiö (the Finnish Medical Foundation). RR received personal research grants from Medicinska Understödsföreningen Liv & Hälsa (the Medical Support Foundation Life & Health) and Finska Läkaresällskapet (the Finnish Medical Association). The funders had no role in the study design, data collection and analysis, the decision to publish, or preparation of the manuscript.

Keywords

cerebral hemorrhage
cost of illness
critical care
health care costs
Stroke

Publication forum classification

Publication forum level 1

ASJC Scopus subject areas

Clinical Neurology
Cardiology and Cardiovascular Medicine

Access to Document

10.1177/23969873221094705Licence: CC BY

23969873221094705Final published version, 1.22 MBLicence: CC BY

https://urn.fi/URN:NBN:fi:tuni-202206015412Licence: CC BY

Cite this

@article{7915c1dfdc184a0f99ca430fe01c531d,

title = "One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit",

abstract = "Background: Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking. Methods: Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs. Results: Twelve-month mortality was 45\% and 51\% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45\%, 39\%, and 16\%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs. Conclusions: Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.",

keywords = "cerebral hemorrhage, cost of illness, critical care, health care costs, Stroke",

author = "Marika Smeds and Skrifvars, \{Markus B.\} and Matti Reinikainen and Stepani Bendel and Sanna Hoppu and Ruut Laitio and Tero Ala-Kokko and Sami Curtze and Gerli Sibolt and Nicolas Martinez-Majander and Rahul Raj",

note = "Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare the following conflicts of interest: Dr. Smeds reports independent research grants from Finska L{\"a}kares{\"a}llskapet (the Finnish Medical Association) and Suomen L{\"a}{\"a}ketieteen S{\"a}{\"a}ti{\"o} (the Finnish Medical Foundation) during the conduct of the study. Dr. Raj reports personal research grants from Finska L{\"a}kares{\"a}llskapet (the Finnish Medical Association) and Medicinska Underst{\"o}dsf{\"o}reningen Liv \& H{\"a}lsa (the Medical Support Foundation Life \& Health). Professor Markus Skrifvars reports speaker fees and travel grants from BARD Medical (Ireland). Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from Finska L{\"a}kares{\"a}llskapet, Suomen L{\"a}{\"a}ketieteen S{\"a}{\"a}ti{\"o}, Medicinska Underst{\"o}dsf{\"o}reningen Liv och H{\"a}lsa, and a three-year project grant from University of Helsinki (H3702, WBS 73702705). MS received a personal research grant from Finska L{\"a}kares{\"a}llskapet (the Finnish Medical Association) and Suomen L{\"a}{\"a}ketieteen S{\"a}{\"a}ti{\"o} (the Finnish Medical Foundation). RR received personal research grants from Medicinska Underst{\"o}dsf{\"o}reningen Liv \& H{\"a}lsa (the Medical Support Foundation Life \& Health) and Finska L{\"a}kares{\"a}llskapet (the Finnish Medical Association). The funders had no role in the study design, data collection and analysis, the decision to publish, or preparation of the manuscript. Publisher Copyright: {\textcopyright} European Stroke Organisation 2022.",

year = "2022",

doi = "10.1177/23969873221094705",

language = "English",

volume = "7",

journal = "European Stroke Journal",

issn = "2396-9873",

publisher = "Sage Publications",

number = "3",

}

TY - JOUR

T1 - One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

AU - Smeds, Marika

AU - Skrifvars, Markus B.

AU - Reinikainen, Matti

AU - Bendel, Stepani

AU - Hoppu, Sanna

AU - Laitio, Ruut

AU - Ala-Kokko, Tero

AU - Curtze, Sami

AU - Sibolt, Gerli

AU - Martinez-Majander, Nicolas

AU - Raj, Rahul

N1 - Funding Information: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors declare the following conflicts of interest: Dr. Smeds reports independent research grants from Finska Läkaresällskapet (the Finnish Medical Association) and Suomen Lääketieteen Säätiö (the Finnish Medical Foundation) during the conduct of the study. Dr. Raj reports personal research grants from Finska Läkaresällskapet (the Finnish Medical Association) and Medicinska Understödsföreningen Liv & Hälsa (the Medical Support Foundation Life & Health). Professor Markus Skrifvars reports speaker fees and travel grants from BARD Medical (Ireland). Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by grants from Finska Läkaresällskapet, Suomen Lääketieteen Säätiö, Medicinska Understödsföreningen Liv och Hälsa, and a three-year project grant from University of Helsinki (H3702, WBS 73702705). MS received a personal research grant from Finska Läkaresällskapet (the Finnish Medical Association) and Suomen Lääketieteen Säätiö (the Finnish Medical Foundation). RR received personal research grants from Medicinska Understödsföreningen Liv & Hälsa (the Medical Support Foundation Life & Health) and Finska Läkaresällskapet (the Finnish Medical Association). The funders had no role in the study design, data collection and analysis, the decision to publish, or preparation of the manuscript. Publisher Copyright: © European Stroke Organisation 2022.

PY - 2022

Y1 - 2022

N2 - Background: Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking. Methods: Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs. Results: Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs. Conclusions: Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

AB - Background: Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking. Methods: Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs. Results: Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs. Conclusions: Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

KW - cerebral hemorrhage

KW - cost of illness

KW - critical care

KW - health care costs

KW - Stroke

U2 - 10.1177/23969873221094705

DO - 10.1177/23969873221094705

M3 - Article

AN - SCOPUS:85130071228

SN - 2396-9873

VL - 7

JO - European Stroke Journal

JF - European Stroke Journal

IS - 3

ER -

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

Abstract

Funding

Keywords

Publication forum classification

ASJC Scopus subject areas

Access to Document

Fingerprint

Cite this