Introduction: Dysphagia (i.e., disordered swallowing) is a consequence of stroke. Existing literature on the marginal cost of dysphagia after stroke is limited and ignores long-term impacts. Our aim was to determine the marginal 12-month cost attributable to dysphagia, including health-related quality of life (HRQoL) impacts, among patients hospitalised with stroke in New Zealand.
Methods: Secondary analysis of observational data from the REGIONS Care study, a national study from New Zealand of consecutively hospitalised patients with acute stroke between 1st May 2018 and 30th October 2018 including an outcome survey at 12 months among those who provided consent. Patients were identified as dysphagic if they received a swallow screen in hospital resulting in a Speech Language Therapist review. Patients that required a nasogastric feeding tube in hospital were classified as 'severe'. Optimal linear propensity score matching was utilised to provide a group for patients to compare with stroke and dysphagia. All costs were converted to 2021NZ$.
Results: Overall, of the 2,379 patients in the REGIONS cohort (51% male, median age:78), 40% (944/2,379) were dysphagic (52% male, median age: 78), and 5% (111/2,379) were classified as severely dysphagic. Within 12-months of hospital discharge, dysphagia reduced HRQoL overall by 0.06 index points (95%CI, 0.028 to 0.100), and severe dysphagia by 0.12 index points (95%CI, 0.03 to 0.20). The estimated marginal 12-month cost attributable to stroke-related dysphagia was $24,200 on average per patient. This estimate includes the additional hospitalisation costs ($16,100), community rehabilitation services ($570), hospital-level aged residential care ($4,030) and reduced HRQoL ($3,470) over a 12-month period post-hospital discharge. The overall total marginal cost for those with severe dysphagia was $34,000 per patient.
Discussion/conclusion: We report cost estimates to 12 months from a national perspective on the additional costs and HRQoL outcomes of dysphagia for people hospitalised with stroke in New Zealand. Findings provide a novel contribution internationally since few prior studies have extended beyond the acute hospital phase of care. By quantifying the economic burden, we provide information to decision makers to improve dysphagia management strategies and ultimately enhance the overall HRQoL for people with stroke and dysphagia.
S. Karger AG, Basel.