Stroke resource utilisation and all-cause mortality in Thailand 2017–2020: A retrospective, cross-sectional study

• Published in: BMJ open Vol. 13; no. 6; p. e072259
• Main Authors: Kumluang, Suthasinee, Wu, Olivia, Langhorne, Peter, Geue, Claudia
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 06.06.2023; BMJ Publishing Group LTD; BMJ Publishing Group
• Series: Original research
• Subjects: Age; Aged; Brain Ischemia; Comorbidity; Costs; Cross-Sectional Studies; Female; health services administration & management; Health Services Research; Hemorrhagic Stroke; Hospitals; Humans; Ischemia; Length of Stay; Male; Mortality; Patients; quality in health care; Rehabilitation; Retrospective Studies; Stroke; Stroke Rehabilitation; Survival analysis; Thailand - epidemiology; Variables; Thailand; stroke; quality in health care; health services administration & management
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-072259

ObjectiveTo determine resource utilisation, costs and all-cause mortality related to stroke in Thailand.DesignRetrospective, cross-sectional study.Setting and participantsPatients with first-ever stroke in the Thai national claims database between 2017 and 2020 were included for analysis. No individuals were involved.MethodsWe estimated annual treatment costs using two-part models. Survival analysis for all-cause mortality was performed.ResultsWe identified 386 484 patients with incident stroke of which 56% were men. Mean age was 65 years and ischaemic stroke was the most common subtype. Mean annual cost per patient was 37 179 Thai Baht (95% CI: 36 988 to 37 370). Haemorrhagic stroke was predominantly observed in the youngest age groups with the highest estimated mean annual cost. Patients with haemorrhagic stroke also had a longer length of stay (LOS) in hospital and an increased risk of mortality. Key cost drivers were identified to be age, LOS, comorbidity and thrombolysis. Costs were lower in patients who received rehabilitation; however, only 32% of patients received rehabilitation services. The 4-year survival rate of all stroke types was 66.5% (95% CI: 64.3% to 66.7%). Older age, high comorbidity score, long LOS and being treated outside the Bangkok area were factors associated with significantly increased mortality risk, while receiving thrombolysis or rehabilitation was associated with a decreased risk of death.ConclusionThe highest mean cost per patient was found in patients with haemorrhagic stroke. Receiving rehabilitation was associated with lower cost and mortality risk. Rehabilitation and disability outcomes should be improved to ensure an enhancement of health outcomes and efficient use of resources.