KISSIMMEE, Fla., Feb. 17 - International Stroke Congress (ISC) - /PRNewswire-FirstCall/ -- Study results presented today at the International Stroke Congress (ISC) in Florida highlight the increasing financial burden caused by the outcomes of acute ischemic stroke and its impact on a variety of healthcare resources. The data show the effect of long-term disability caused by stroke on healthcare resources and emphasize the importance of wide economic assessment in evaluating the benefit of new stroke treatments.
One of the studies presented examined the impact of the length and cost of hospital stays on the ability of hospitals to treat ischemic patients. U.S. researchers analyzed more than 350,000 Medicare health insurance claims to estimate the current cost of providing standard inpatient stroke care, based on a mean hospital stay of 5.7 days(1). The study found that while the mean cost per stay for a stroke patient was $9,433, the average amount actually reimbursed per stay came to $6,589, representing an average shortfall to the hospital of $2,845 per patient stay. To provide standard stroke care on a break-even basis, the average hospital stay would need to be reduced to just 3.5 days. These findings are especially significant given that 72% of acute stroke patients in the U.S. are Medicare beneficiaries(1).
A second study provided further evidence of the impact of reimbursement issues on patients hospitalized with ischemic or hemorrhagic stroke, revealing that various financial incentives over the past decade have led to a decrease in the initial intensity of care for patients with stroke. Such financial incentives include reducing the in-patient length of stay and making the criteria for rehabilitation reimbursement more stringent(2).
This study looked at the four highest expense categories; hospital, physician, rehabilitation and skilled nursing costs for ischemic and hemorrhagic stroke, averaged over a 12-month period, using standardized methods to compare Medicare claims filed for 1991 with those from 2000. The study found that, while a slight reduction was seen in the total 12-month cost of stroke between 1991 and 2000, the overall mix of costs changed with more expenditure on skilled nursing and less on hospital, physician and rehabilitation.
Lead study author Dr. David Matchar, Director and Professor of Medicine, Center for Clinical Health Policy Research, Duke University Medial Center, U.S., commented, "Current financial pressures create disincentives for acute therapy, including future medications or aggressive rehabilitation. These disincentives do not serve stroke patients who have the potential to not only survive, but to survive with good function. The irony is that these financial pressures don't seem to be saving cost overall. We see from our cost studies that squeezing the balloon on the acute care side only leads to expansion on the long-term care side. If we truly want to improve stroke outcomes we must address these perverse financial pressures."
Another significant finding highlighted by data presented at the ISC is the increasing importance of the modified Rankin Scale (mRS) for assessing post-stroke disability and its economic impact(3). When evaluating data from a long-term registry of patients with stroke, investigators studied the course of disability over time, moving beyond the 3-month period typically evaluated in clinical trials.
This study concluded that while most changes in mRS are seen in the first 3 months, patients may continue to recover or deteriorate further due to recurrent stroke. Since disability is known to be a strong predictor of care need, and thus cost, these changes need to be accounted for in economic evaluations of stroke treatment.
"When evaluating the cost of managing these acute stroke patients, one needs to consider the entire spectrum of health care required, as disability following stroke leads to many different care needs over the long term. The modified Rankin Scale is a measurement of disability useful for economic evaluations of the impact of stroke, provided that longer term changes in disability are accounted for when assessing economic implications," commented Dr. Jaime Caro, Lead Study Author and Scientific Director, Caro Research Institute, Massachusetts, U.S.
While the majority of people survive an ischemic stroke, many are left with some form of disability; up to a third of sufferers remain functionally dependent one year after their stroke, requiring long-term medical care or institutionalization(4). This results in considerable healthcare costs. In the US, stroke costs more than $56.8 billion annually, 62 percent of which is accounted for by hospital and home care costs(5); while in Europe, stroke management accounts for 5-10 percent of healthcare resources(6).
AstraZeneca funded these studies and is committed to research in the area of stroke in order to understand the burden of stroke and how the effects of acute ischemic stroke can be reduced.
Dr. Tomas Odergren, Global Product Director, AstraZeneca, said: "The findings from these health economic studies show only too clearly the profound impact of managing acute ischemic stroke, as the premier cause of adult disability, on the healthcare sector and society. The suffering of the patients and families and the impact noted on healthcare resources, make the development of new broadly applicable treatments that reduce post-stroke disability more critical than ever."
AstraZeneca is a major international healthcare business engaged in the research, development, manufacture and marketing of prescription pharmaceuticals and the supply of healthcare services. It is one of the world's leading pharmaceutical companies with healthcare sales of $23.95 billion and leading positions in sales of gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infection products. In the United States, AstraZeneca is a $10.77 billion healthcare business with more than 12,000 employees. AstraZeneca is listed in the Dow Jones Sustainability Index (Global) as well as the FTSE4Good Index. For more information about AstraZeneca, please visit: http://www.astrazeneca-us.com/.
References:
1. Marotta C, Scharf J, Mafilios M, et al. Impact of length of stay and
costs on the ability of hospitals to adopt new technology for the
treatment of acute ischemic stroke patients. Poster presented at the
International Stroke Conference 2006, Kissimmee, FL, USA
2. Matchar D, Goss T, Samsa G, et al. An Examination of Patterns of 12-
Month Medicare Reimbursements for Patients Hospitalized with Ischemic
or Hemorrhagic Stroke in 1991 versus 2000. Poster presented at the
International Stroke Conference 2006, Kissimmee, FL, USA
3. Caro J, Huybrechts K, Vemmos K. Stroke Economic Models; Importance of
Predicting Time Course of Recovery. Poster presented at the
International Stroke Conference 2006, Kissimmee, FL, USA
4. Murray CJL, Lopez AD. The Global Burden of Disease: a comprehensive
assessment of mortality and disability from diseases, injuries, and
risk factors in 1990 and projected to 2020. Boston: Harvard University
Press; 1996.
5. American Stroke Association, American Heart Association. Heart Disease
and Stroke Statistics - 2005 Update.
(http://www.americanheart.org/downloadable/heart/
1105390918119HDSStats2005Update.pdf)
6. Hacke W, Kaste M, Skyhoj Olsen T, et al. J.European Stroke Initiative
(EUSI) recommendations for stroke management. The European Stroke
Initiative Writing Committee. Eur J Neurol. 2000; 6: 607-23.
First Call Analyst:
FCMN Contact: Cheryl.vitale@astrazeneca.com
