Research Article: Relationship between functional disability and costs one and two years post stroke

Date Published: April 6, 2017

Publisher: Public Library of Science

Author(s): Ingrid Lekander, Carl Willers, Mia von Euler, Mikael Lilja, Katharina S. Sunnerhagen, Hélène Pessah-Rasmussen, Fredrik Borgström, Johannes Boltze.


Stroke affects mortality, functional ability, quality of life and incurs costs. The primary objective of this study was to estimate the costs of stroke care in Sweden by level of disability and stroke type (ischemic (IS) or hemorrhagic stroke (ICH)).

Resource use during first and second year following a stroke was estimated based on a research database containing linked data from several registries. Costs were estimated for the acute and post-acute management of stroke, including direct (health care consumption and municipal services) and indirect (productivity losses) costs. Resources and costs were estimated per stroke type and functional disability categorised by Modified Rankin Scale (mRS).

The results indicated that the average costs per patient following a stroke were 350,000SEK/€37,000–480,000SEK/€50,000, dependent on stroke type and whether it was the first or second year post stroke. Large variations were identified between different subgroups of functional disability and stroke type, ranging from annual costs of 100,000SEK/€10,000–1,100,000SEK/€120,000 per patient, with higher costs for patients with ICH compared to IS and increasing costs with more severe functional disability.

Functional outcome is a major determinant on costs of stroke care. The stroke type associated with worse outcome (ICH) was also consistently associated to higher costs. Measures to improve function are not only important to individual patients and their family but may also decrease the societal burden of stroke.

Partial Text

Stroke is caused by ischemia (ischemic stroke, IS), hemorrhage (intracerebral hemorrhage, ICH) in the brain or subarachnoid hemorrhage (SAH) in the brain. Early acute treatment, which is vital for survival and minimizing brain damage due to the stroke, has improved for IS with development of reperfusion therapy but no curative therapy is yet available for ICH. Still, many patients have remaining disabilities after a stroke, with life-long consequences on functional ability [1] and quality of life [2, 3]. In Sweden, approximately 25,000 patients suffer from an IS or ICH each year [4] and the effects on morbidity, mortality and costs are substantial [1, 5–8].

Functional ability is a strong determinant of cost of stroke in the years following the stroke event. The results from this study indicate higher costs with worse functional disability, up to an eight-fold increase in average per-patient costs during the second year after stroke (comparing mRS 5 to mRS 0–2). These conclusions hold even after stratifying the results by different age groups. This sensitivity analysis further indicated that the youngest population (<60) incurred the highest costs in any level of disability. Previous studies have indicated a similar relationship between functional disability and costs, although estimating costs at a shorter term [23, 24]. This could be of particular interest when estimating cost-benefit of acute treatments such as thrombectomy which has high initial costs but potentially large effects on outcome. If a treatment can shift a patient’s functional outcome from mRS 4–5 to mRS 0–2, the potential benefit could be substantial also in monetary values. It also emphasizes the importance of continuous rehabilitation to maintain functional ability during the years following stroke.   Source:


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