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Costs and outcomes of noncardioembolic ischemic stroke in a managed care population

PURPOSE: To evaluate the clinical outcomes and incremental health care costs of ischemic stroke in a US managed care population. PATIENTS AND METHODS: A retrospective cohort analysis was done on patients (aged 18+ years) hospitalized with noncardioembolic ischemic stroke from January 1, 2002, throug...

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Autores principales: Engel-Nitz, Nicole M, Sander, Stephen D, Harley, Carolyn, Rey, Gabriel Gomez, Shah, Hemal
Formato: Texto
Lenguaje:English
Publicado: Dove Medical Press 2010
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952456/
https://www.ncbi.nlm.nih.gov/pubmed/20957133
http://dx.doi.org/10.2147/VHRM.S10851
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author Engel-Nitz, Nicole M
Sander, Stephen D
Harley, Carolyn
Rey, Gabriel Gomez
Shah, Hemal
author_facet Engel-Nitz, Nicole M
Sander, Stephen D
Harley, Carolyn
Rey, Gabriel Gomez
Shah, Hemal
author_sort Engel-Nitz, Nicole M
collection PubMed
description PURPOSE: To evaluate the clinical outcomes and incremental health care costs of ischemic stroke in a US managed care population. PATIENTS AND METHODS: A retrospective cohort analysis was done on patients (aged 18+ years) hospitalized with noncardioembolic ischemic stroke from January 1, 2002, through December 31, 2003, identified from commercial health plan administrative claims. New or recurrent stroke was based on history in the previous 12 months, with index date defined as first date of indication of stroke. A control group without stroke or transient ischemic attack (TIA) was matched (1:3) on age, sex, and geographic region, with an index date defined as the first medical claim during the patient identification period. Patients with atrial fibrillation or mitral value abnormalities were excluded. Ischemic stroke and control cohorts were compared on 4-year clinical outcomes and 1-year costs. RESULTS: Of 2180 ischemic stroke patients, 1808 (82.9%) had new stroke and 372 (17.1%) had a recurrent stroke. Stroke patients had higher unadjusted rates of additional stroke, TIA, and fatal outcomes compared with the 6540 matched controls. Recurrent stroke patients had higher rates of adverse clinical outcomes compared with new stroke patients; costs attributed to recurrent stroke were also higher. Stroke patients were 2.4 times more likely to be hospitalized in follow-up compared with controls (hazard ratio [HR] 2.4, 95% confidence interval [CI]: 2.2, 2.6). Occurrence of stroke following discharge was 21 times more likely among patients with index stroke compared with controls (HR 21.0, 95% CI: 16.1, 27.3). Stroke was also predictive of death (HR 1.8, 95% CI: 1.3, 2.5). Controlling for covariates, stroke patients had significantly higher costs compared with control patients in the year following the index event. CONCLUSION: Noncardioembolic ischemic stroke patients had significantly poorer outcomes and higher costs compared with controls. Recurrent stroke appears to contribute substantially to these higher rates of adverse outcomes and costs.
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spelling pubmed-29524562010-10-18 Costs and outcomes of noncardioembolic ischemic stroke in a managed care population Engel-Nitz, Nicole M Sander, Stephen D Harley, Carolyn Rey, Gabriel Gomez Shah, Hemal Vasc Health Risk Manag Original Research PURPOSE: To evaluate the clinical outcomes and incremental health care costs of ischemic stroke in a US managed care population. PATIENTS AND METHODS: A retrospective cohort analysis was done on patients (aged 18+ years) hospitalized with noncardioembolic ischemic stroke from January 1, 2002, through December 31, 2003, identified from commercial health plan administrative claims. New or recurrent stroke was based on history in the previous 12 months, with index date defined as first date of indication of stroke. A control group without stroke or transient ischemic attack (TIA) was matched (1:3) on age, sex, and geographic region, with an index date defined as the first medical claim during the patient identification period. Patients with atrial fibrillation or mitral value abnormalities were excluded. Ischemic stroke and control cohorts were compared on 4-year clinical outcomes and 1-year costs. RESULTS: Of 2180 ischemic stroke patients, 1808 (82.9%) had new stroke and 372 (17.1%) had a recurrent stroke. Stroke patients had higher unadjusted rates of additional stroke, TIA, and fatal outcomes compared with the 6540 matched controls. Recurrent stroke patients had higher rates of adverse clinical outcomes compared with new stroke patients; costs attributed to recurrent stroke were also higher. Stroke patients were 2.4 times more likely to be hospitalized in follow-up compared with controls (hazard ratio [HR] 2.4, 95% confidence interval [CI]: 2.2, 2.6). Occurrence of stroke following discharge was 21 times more likely among patients with index stroke compared with controls (HR 21.0, 95% CI: 16.1, 27.3). Stroke was also predictive of death (HR 1.8, 95% CI: 1.3, 2.5). Controlling for covariates, stroke patients had significantly higher costs compared with control patients in the year following the index event. CONCLUSION: Noncardioembolic ischemic stroke patients had significantly poorer outcomes and higher costs compared with controls. Recurrent stroke appears to contribute substantially to these higher rates of adverse outcomes and costs. Dove Medical Press 2010-10-05 2010 /pmc/articles/PMC2952456/ /pubmed/20957133 http://dx.doi.org/10.2147/VHRM.S10851 Text en © 2010 Engel-Nitz et al, publisher and licensee Dove Medical Press Ltd This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
spellingShingle Original Research
Engel-Nitz, Nicole M
Sander, Stephen D
Harley, Carolyn
Rey, Gabriel Gomez
Shah, Hemal
Costs and outcomes of noncardioembolic ischemic stroke in a managed care population
title Costs and outcomes of noncardioembolic ischemic stroke in a managed care population
title_full Costs and outcomes of noncardioembolic ischemic stroke in a managed care population
title_fullStr Costs and outcomes of noncardioembolic ischemic stroke in a managed care population
title_full_unstemmed Costs and outcomes of noncardioembolic ischemic stroke in a managed care population
title_short Costs and outcomes of noncardioembolic ischemic stroke in a managed care population
title_sort costs and outcomes of noncardioembolic ischemic stroke in a managed care population
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2952456/
https://www.ncbi.nlm.nih.gov/pubmed/20957133
http://dx.doi.org/10.2147/VHRM.S10851
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