DIRECT COSTS AND ECONOMIC BURDEN OF ACUTE ISCHEMIC STROKE IN THE BRAZILIAN PRIVATE HEALTH SYSTEM: A REAL-WORLD RETROSPECTIVE COHORT
Author(s)
Kathiaja Miranda Souza, PhD1, Magali Caregatti, MBA2, Robson Bruniera de Oliveira, PhD2, Fernandes Taís Bertoldo Teixeira, MBA2.
1Boehringer Ingelheim, São Paulo, Brazil, 2Orizon Healthtech, São Paulo, Brazil.
1Boehringer Ingelheim, São Paulo, Brazil, 2Orizon Healthtech, São Paulo, Brazil.
OBJECTIVES: To assess healthcare resource utilization and direct medical costs of patients with acute ischemic stroke (AIS) in the Brazilian private health system, characterizing components driving total cost.
METHODS: Retrospective cohort using an administrative billing database of a private company (Orizon), representative of the Brazilian private health system (approximately 8.8 million covered lives in 2024). Beneficiaries with AIS (ICD-10 I63, I64, I65, I66) were identified between January 2018 and December 2024 and followed through March 2025. Healthcare resource utilization (hospital admissions, length of stay, intensive care unit (ICU) use, rehabilitation) and direct costs (overall treatment, hospitalization, ICU, and rehabilitation) were analyzed. Costs were aggregated per beneficiary and inflation-adjusted to March 2025 (IPCA); total, mean, and median costs and regional distribution were calculated.
RESULTS: 31,682 beneficiaries were included. Total direct costs reached R$7.4 billion, rising from R$728.7 million (2018) to R$1.12 billion (2024). Hospitalization was the principal cost driver, accounting for R$6.6 billion (~89% of total), with ICU care representing R$5.0 billion (~68% of total); rehabilitation, received by 44.7% of patients, represented only R$18.9 million (~0.3%). Overall, 74% of patients required ICU admission, with mean ICU stay 36.8 days and overall mean stay 28.9 days. Mean cost per beneficiary declined from R$141,900 (2018) to R$80,200 (2024), and medians from R$38,500 to R$18,100, indicating a right-skewed distribution driven by high-complexity cases. ICU mean cost per beneficiary remained high (R$159,900 in 2018; R$142,000 in 2024). Expenditure was geographically concentrated, with the Southeast accounting for ~R$5.07 billion (~68%).
CONCLUSIONS: AIS imposes a substantial and growing economic burden on the Brazilian private health system, overwhelmingly concentrated in inpatient and intensive care, while low-cost rehabilitation remains marginal. The dominance of ICU-driven hospitalization and marked regional concentration highlight opportunities to optimize acute-phase care pathways and resource allocation. These real-world cost estimates can inform value-based decision-making and budgeting.
METHODS: Retrospective cohort using an administrative billing database of a private company (Orizon), representative of the Brazilian private health system (approximately 8.8 million covered lives in 2024). Beneficiaries with AIS (ICD-10 I63, I64, I65, I66) were identified between January 2018 and December 2024 and followed through March 2025. Healthcare resource utilization (hospital admissions, length of stay, intensive care unit (ICU) use, rehabilitation) and direct costs (overall treatment, hospitalization, ICU, and rehabilitation) were analyzed. Costs were aggregated per beneficiary and inflation-adjusted to March 2025 (IPCA); total, mean, and median costs and regional distribution were calculated.
RESULTS: 31,682 beneficiaries were included. Total direct costs reached R$7.4 billion, rising from R$728.7 million (2018) to R$1.12 billion (2024). Hospitalization was the principal cost driver, accounting for R$6.6 billion (~89% of total), with ICU care representing R$5.0 billion (~68% of total); rehabilitation, received by 44.7% of patients, represented only R$18.9 million (~0.3%). Overall, 74% of patients required ICU admission, with mean ICU stay 36.8 days and overall mean stay 28.9 days. Mean cost per beneficiary declined from R$141,900 (2018) to R$80,200 (2024), and medians from R$38,500 to R$18,100, indicating a right-skewed distribution driven by high-complexity cases. ICU mean cost per beneficiary remained high (R$159,900 in 2018; R$142,000 in 2024). Expenditure was geographically concentrated, with the Southeast accounting for ~R$5.07 billion (~68%).
CONCLUSIONS: AIS imposes a substantial and growing economic burden on the Brazilian private health system, overwhelmingly concentrated in inpatient and intensive care, while low-cost rehabilitation remains marginal. The dominance of ICU-driven hospitalization and marked regional concentration highlight opportunities to optimize acute-phase care pathways and resource allocation. These real-world cost estimates can inform value-based decision-making and budgeting.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE161
Topic
Economic Evaluation, Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)