Predictors of acute hospital costs for treatment of ischemic stroke in an academic center

• Published in: Stroke (1970) Vol. 30; no. 4; pp. 724 - 728
• Main Authors: DIRINGER, M. N, EDWARDS, D. F, MATTSON, D. T, AKINS, P. T, SHEEDY, C. W, HSU, C. Y, DROMERICK, A. W
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.04.1999; American Heart Association, Inc
• Subjects: Academic Medical Centers - economics; Acute Disease; Aged; Aged, 80 and over; Atrial Fibrillation - economics; Beds - economics; Biological and medical sciences; Brain Ischemia - economics; Cerebrovascular Disorders - economics; Cost Allocation; Costs and Cost Analysis; Female; Hospital Costs - classification; Hospital Costs - statistics & numerical data; Humans; Insurance, Health; Male; Medical sciences; Middle Aged; Neurology; Outcome Assessment (Health Care) - economics; Patient Care Team - economics; Prospective Studies; Regression Analysis; Severity of Illness Index; United States; Vascular diseases and vascular malformations of the nervous system; United States; North America; America; Human; Nervous system diseases; Stroke; Average cost; Cardiovascular disease; Hospitalization; Cerebral disorder; Vascular disease; Ischemia; Health economy; Central nervous system disease; Cost analysis; Predictive factor; Cerebrovascular disease; Public health
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.30.4.724

We sought to determine predictors of acute hospital costs in patients presenting with acute ischemic stroke to an academic center using a stroke management team to coordinate care. Demographic and clinical data were prospectively collected on 191 patients consecutively admitted with acute ischemic stroke. Patients were classified by insurance status, premorbid modified Rankin scale, stroke location, stroke severity (National Institutes of Health Stroke Scale score), and presence of comorbidities. Detailed hospital charge data were converted to cost by application of department-specific cost-to-charge ratios. Physician's fees were not included. A stepwise multiple regression analysis was computed to determine the predictors of total hospital cost. Median length of stay was 6 days (range, 1 to 63 days), and mortality was 3%. Median hospital cost per discharge was $4408 (range, $1199 to $59 799). Fifty percent of costs were for room charges, 19% for stroke evaluation, 21% for medical management, and 7% for acute rehabilitation therapies. Sixteen percent were admitted to an intensive care unit. Length of stay accounted for 43% of the variance in total cost. Other independent predictors of cost included stroke severity, heparin treatment, atrial fibrillation, male sex, ischemic cardiac disease, and premorbid functional status. We conclude that the major predictors of acute hospital costs of stroke in this environment are length of stay, stroke severity, cardiac disease, male sex, and use of heparin. Room charges accounted for the majority of costs, and attempts to reduce the cost of stroke evaluation would be of marginal value. Efforts to reduce acute costs should be monitored for potential cost shifting or a negative impact on quality of care.