Estimating the Burden of Stroke: Two-Year Societal Costs and Generic Health-Related Quality of Life of the Restore4Stroke Cohort

Ghislaine van Mastrigt; Caroline van Heugten; Anne Visser-Meily; Leonarda Bremmers; Silvia Evers

doi:10.3390/ijerph191711110

Estimating the Burden of Stroke: Two-Year Societal Costs and Generic Health-Related Quality of Life of the Restore4Stroke Cohort

Int J Environ Res Public Health. 2022 Sep 5;19(17):11110. doi: 10.3390/ijerph191711110.

Authors

Ghislaine van Mastrigt¹, Caroline van Heugten^{2

3}, Anne Visser-Meily⁴, Leonarda Bremmers⁵, Silvia Evers^{1

6}

Affiliations

¹ Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200 MD Maastricht, The Netherlands.
² MHeNS, School for Mental Health & Neuroscience, Department of Psychiatry & Psychology, Faculty of Health Medicine and Life Sciences, Maastricht University, 6229 ER Maastricht, The Netherlands.
³ Department of Neuropsychology & Psychopharmacology, Faculty of Psychology & Neuroscience, Maastricht University, 6229 ER Maastricht, The Netherlands.
⁴ Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands.
⁵ Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University, 3062 PA Rotterdam, The Netherlands.
⁶ Trimbos Institute, Netherlands Institute of Mental Health and Addiction Utrecht, 3521 VS Utrechtcity, The Netherlands.

Abstract

(1) Background: This study aimed to investigate two-year societal costs and generic health-related quality of life (QoL) using a bottom-up approach for the Restore4Stroke Cohort. (2) Methods: Adult post-stroke patients were recruited from stroke units throughout the Netherlands. The societal costs were calculated for healthcare and non-healthcare costs in the first two years after stroke. The QoL was measured using EQ-5D-3L. The differences between (sub)groups over time were investigated using a non-parametric bootstrapping method. (3) Results: A total of 344 post-stroke patients were included. The total two-year societal costs of a post-stroke were EUR 47,502 (standard deviation (SD = EUR 2628)). The healthcare costs decreased by two thirds in the second year -EUR 14,277 (95% confidence interval -EUR 17,319, -EUR 11,236). In the second year, over 50% of the total societal costs were connected to non-healthcare costs (such as informal care, paid help, and the inability to perform unpaid labor). Sensitivity analyses confirmed the importance of including non-healthcare costs for long-term follow-up. The subgroup analyses showed that patients who did not return home after discharge, and those with moderate to severe stroke symptoms, incurred significantly more costs compared to patients who went directly home and those who reported fewer symptoms. QoL was stable over time except for the stroke patients over 75 years of age, where a significant and clinically meaningful decrease in QoL over time was observed. (4) Conclusions: The non-healthcare costs have a substantial impact on the first- and second-year total societal costs post-stroke. Therefore, to obtain a complete picture of all the relevant costs related to a stroke, a societal perspective with a follow-up of at least two years is highly recommended. Additionally, more research is needed to investigate the decline in QoL found in stroke patients above the age of 75 years.

Keywords: burden of disease; costs-of-illness; longitudinal cohort; quality of life; societal costs; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cohort Studies
Cost of Illness
Health Care Costs
Humans
Patient Care
Quality of Life*
Stroke* / therapy

Grants and funding

This work research was funded by the VSBfund (Dutch organization for supporting Dutch society with money, knowledge and networks, PO Box 16, 3500 AA, Utrecht, The Netherlands, project number 60-61300-98-022), the Dutch Heart Foundation (PO Box 300 2501 CH Den Haag, the Netherlands) and coordinated by Zon-Mw (Dutch Organisation for Health Research and Development). The funding bodies were not involved in the design of the study, collection, analysis, interpretation of data, or writing of the manuscript.