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Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study

OBJECTIVES: To evaluate how costs of healthcare can be reduced, there is an increasing need to gain insight into the main drivers of such costs. We evaluated drivers of costs of predefined subgroups of patients who had a stroke by linking cost registration with clinical data. METHODS: We retrospecti...

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Autores principales: Mensing, Liselore A, Kappelle, L Jaap, Koffijberg, Hendrik, Ruigrok, Ynte M
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9815001/
https://www.ncbi.nlm.nih.gov/pubmed/36596637
http://dx.doi.org/10.1136/bmjopen-2022-064445
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author Mensing, Liselore A
Kappelle, L Jaap
Koffijberg, Hendrik
Ruigrok, Ynte M
author_facet Mensing, Liselore A
Kappelle, L Jaap
Koffijberg, Hendrik
Ruigrok, Ynte M
author_sort Mensing, Liselore A
collection PubMed
description OBJECTIVES: To evaluate how costs of healthcare can be reduced, there is an increasing need to gain insight into the main drivers of such costs. We evaluated drivers of costs of predefined subgroups of patients who had a stroke by linking cost registration with clinical data. METHODS: We retrospectively selected 555 consecutive patients with ischaemic stroke participating between June 2011 and December 2016 in the Dutch Parelsnoer Initiative. Patient characteristics and costs of healthcare activities during hospital admission and the first 3 months after discharge were linked. Patients were divided in subgroups based on age, severity of stroke, stroke subtype, discharge destination and functional outcome. Unit cost per healthcare activity was based on 2018 rates for mutual service in euros. Mean total costs per subgroup were calculated. Multivariate analysis was performed to identify factors associated with costs. RESULTS: Number of admitted days was the main driver of total hospital costs (range 82%–93%) in all predefined subgroups of patients. Second driver was radiological diagnostic investigations (range 2%–9%). Highest costs were observed in patients with a younger age at the time of admission, a higher modified Rankin Scale at the time of discharge and a nursing home as discharge destination. The distribution of costs over the different healthcare activities was associated with stroke subtype; for example, in patients with a cardiac embolism most costs were spent on cardiology-related healthcare activities. CONCLUSION: The number of admitted days was the most important driver of costs in all subgroups of patients with ischaemic stroke. This implicates that to reduce healthcare costs for patients who had a stroke, focus should be on reducing length of hospital stay.
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spelling pubmed-98150012023-01-06 Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study Mensing, Liselore A Kappelle, L Jaap Koffijberg, Hendrik Ruigrok, Ynte M BMJ Open Neurology OBJECTIVES: To evaluate how costs of healthcare can be reduced, there is an increasing need to gain insight into the main drivers of such costs. We evaluated drivers of costs of predefined subgroups of patients who had a stroke by linking cost registration with clinical data. METHODS: We retrospectively selected 555 consecutive patients with ischaemic stroke participating between June 2011 and December 2016 in the Dutch Parelsnoer Initiative. Patient characteristics and costs of healthcare activities during hospital admission and the first 3 months after discharge were linked. Patients were divided in subgroups based on age, severity of stroke, stroke subtype, discharge destination and functional outcome. Unit cost per healthcare activity was based on 2018 rates for mutual service in euros. Mean total costs per subgroup were calculated. Multivariate analysis was performed to identify factors associated with costs. RESULTS: Number of admitted days was the main driver of total hospital costs (range 82%–93%) in all predefined subgroups of patients. Second driver was radiological diagnostic investigations (range 2%–9%). Highest costs were observed in patients with a younger age at the time of admission, a higher modified Rankin Scale at the time of discharge and a nursing home as discharge destination. The distribution of costs over the different healthcare activities was associated with stroke subtype; for example, in patients with a cardiac embolism most costs were spent on cardiology-related healthcare activities. CONCLUSION: The number of admitted days was the most important driver of costs in all subgroups of patients with ischaemic stroke. This implicates that to reduce healthcare costs for patients who had a stroke, focus should be on reducing length of hospital stay. BMJ Publishing Group 2023-01-03 /pmc/articles/PMC9815001/ /pubmed/36596637 http://dx.doi.org/10.1136/bmjopen-2022-064445 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Neurology
Mensing, Liselore A
Kappelle, L Jaap
Koffijberg, Hendrik
Ruigrok, Ynte M
Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
title Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
title_full Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
title_fullStr Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
title_full_unstemmed Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
title_short Drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
title_sort drivers of healthcare costs in patients with ischaemic stroke: a hospital-based retrospective cohort study
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9815001/
https://www.ncbi.nlm.nih.gov/pubmed/36596637
http://dx.doi.org/10.1136/bmjopen-2022-064445
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