Cost of Stroke in Latin America: A Multicentric Time-Driven Activity-Based Costing Study

Speaker(s)

Dittrich L1, Etges AP2, Souza JS1, Marcolino MAZ2, Rocha E3, Amaya P4, Barboza M5, Saavedra AG6, Hornos GP6, Abanto C7, Castillo-Soto AL7, Llanos-Leyton N8, Pujol Lereis V9, Pérez MSR9, Alet M9, Navia V10, Lopez S10, Arauz A11, Serrano F11, Chwal B12, Carbonera LA13, Nogueira RG14, Saposnik G15, Polanczyk CA2, Martins S13, Souza AC13
1Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil, 2National Institute of Science and Technology for Health Technology Assessment (INCT-IATS), Porto Alegre, RS, Brazil, 3Federal University of São Paulo, São Paulo, SP, Brazil, 4Fundación Vale del Lili, Cali, Valle del Cauca, Colombia, 5Hospital Dr. Rafael A. Calderon Guardia, San José, San José, Costa Rica, 6Instituto de Neurología, Hospital de Clínicas, Montevidéu, Departamento de Montevidéu, Uruguay, 7National Institute of Neurological Sciences, Lima, Lima, Peru, 8Fundación Valle del Lili, Cali, Valle del Cauca, Colombia, 9FLENI Hospital, Buenos Aires, Buenos Aires, Argentina, 10Hospital Padre Hurtado, Santiago, Región Metropolitana, Chile, 11Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Mexico City, Mexico, 12Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil, 13Hospital Moinhos de Vento, Porto Alegre, Brazil, 14University of Pittsburgh School of Medicine, Pittsburgh, PA, USA, 15University of Toronto, Toronto, ON, Canada

OBJECTIVES: Given the significant global health challenge posed by stroke, this study aims to measure stroke costs in Latin American countries by analyzing the precise costs of acute ischemic stroke and their regional variabilities using accurate microcosting techniques.

METHODS: A comprehensive international multicenter study evaluated the direct costs of patients admitted with acute ischemic stroke from December 2021 to December 2022. Data were collected from stroke centers in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, Peru, and Uruguay. Direct costs were assessed using a microcosting method. Factors considered included favorable outcomes (modified Rankin Scale (mRS) 0-2), clinical risk levels (age and stroke severity), and treatment interventions (medical treatment alone, intravenous thrombolysis, and mechanical thrombectomy). Purchasing power parity adjustments and international dollar conversions facilitated cross-country comparisons. Descriptive analyses were performed stratified by country and Generalized Estimating Equation models assessed the relationship between clinical variables and total cost per patient.

RESULTS: The study included 1,106 patients. Among them, 74% received medical treatment alone, 18% received IVT, 4% underwent MT, and 3% received combined IVT and MT. Costs increased with patients clinical risk, outcomes, and treatment options. MT incurred costs 3.1 times higher than medical treatment alone, with an incremental cost of I$20,418 per patient (p < 0.001). Treating high-risk patients incurred substantial cost increases of I$7,512 compared to medium-risk patients (p < 0.0001) and I$7,866 compared to low-risk patients (p < 0.0001). Patients in the mRS 5-6 categories had costs twice as high as those in the mRS 0-2 categories.

CONCLUSIONS: The study reveals disparities in stroke costs across Latin America, offering a comprehensive understanding into the economic landscape and cost variations factors, particularly in under-researched regions. Continued investment in evidence-based research and value-based care models is essential to ensure equitable access and reduce disabilities and deaths.

Code

EE277

Topic

Economic Evaluation

Topic Subcategory

Trial-Based Economic Evaluation

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory)