ECONOMIC BURDEN OF STROKE ON BRAZIL'S UNIFIED HEALTH SYSTEM: DIRECT HEALTHCARE COSTS AND ESTIMATED PRODUCTIVITY LOSSES, 2017-2023
Author(s)
Kathiaja Miranda Souza, PhD1, Fernanda Melo, MSc2, Leon Nascimento, PhD2.
1Boehringer Ingelheim, São Paulo, Brazil, 2Centro de Inovação SESI Saúde Ocupacional (FIRJAN), Rio de Janeiro, Brazil.
1Boehringer Ingelheim, São Paulo, Brazil, 2Centro de Inovação SESI Saúde Ocupacional (FIRJAN), Rio de Janeiro, Brazil.
OBJECTIVES: Stroke is a leading cause of death and long-term disability in Brazil, yet its economic burden on the public payer remains poorly characterized. We estimated stroke-attributable direct healthcare costs within the Brazilian Unified Health System (SUS) and productivity associated with social-security benefits and lost workdays over 2017-2023.
METHODS: Observational, descriptive, population-based time-series study using national administrative databases: the Hospital (SIH), Outpatient (SIA), and Mortality (SIM) Information Systems of DataSUS; INSS social-security benefit registries; and the National Registry of Health Establishments (CNES). Cases were identified by ICD-10 codes I60, I61, I62, I63, I64, I66, I67, G45, and G46. Collected variables included hospitalizations (volume, length of stay, total and mean cost), general and in-hospital deaths, case-fatality, outpatient visits, neurologists, CT scanners, ambulances, granted/active INSS benefits, and associated lost workdays. Direct costs were derived from SIH/DataSUS hospitalization expenditure. Productivity losses were estimated separately via the human-capital approach: a wage-based loss (lost workdays × mean daily benefit value) and a GDP-based nationalized loss (lost workdays × GDP per working-age individual).
RESULTS: From 2017 t0 2023, stroke generated 1,677,005 hospitalizations and 484,324 deaths nationwide. Mean direct cost per hospitalization varied regionally (e.g., R$1,629.83 in the North; R$2,034.31 in the South). Social-security expenditure reached R$228.5 million in December 2023 (126,114 active benefits; 68.6% temporary sickness benefits), annualized at R$2.74 billion. Distinctly, stroke caused 161,658,795 lost workdays, yielding a wage-based productivity loss of R$10.09 billion and a GDP-based loss of R$7.15 billion. The Southeast concentrated the highest absolute burden. Estimates are conservative, as beneficiary turnover was not modeled.
CONCLUSIONS: Stroke imposes a substantial, economic burden on Brazil's public system, with productivity losses in the order of billions of reais compounding direct care costs. The magnitude of this burden and regional cost variationunderscore the value of investment in prevention and timely acute stroke care to curb avoidable costs.
METHODS: Observational, descriptive, population-based time-series study using national administrative databases: the Hospital (SIH), Outpatient (SIA), and Mortality (SIM) Information Systems of DataSUS; INSS social-security benefit registries; and the National Registry of Health Establishments (CNES). Cases were identified by ICD-10 codes I60, I61, I62, I63, I64, I66, I67, G45, and G46. Collected variables included hospitalizations (volume, length of stay, total and mean cost), general and in-hospital deaths, case-fatality, outpatient visits, neurologists, CT scanners, ambulances, granted/active INSS benefits, and associated lost workdays. Direct costs were derived from SIH/DataSUS hospitalization expenditure. Productivity losses were estimated separately via the human-capital approach: a wage-based loss (lost workdays × mean daily benefit value) and a GDP-based nationalized loss (lost workdays × GDP per working-age individual).
RESULTS: From 2017 t0 2023, stroke generated 1,677,005 hospitalizations and 484,324 deaths nationwide. Mean direct cost per hospitalization varied regionally (e.g., R$1,629.83 in the North; R$2,034.31 in the South). Social-security expenditure reached R$228.5 million in December 2023 (126,114 active benefits; 68.6% temporary sickness benefits), annualized at R$2.74 billion. Distinctly, stroke caused 161,658,795 lost workdays, yielding a wage-based productivity loss of R$10.09 billion and a GDP-based loss of R$7.15 billion. The Southeast concentrated the highest absolute burden. Estimates are conservative, as beneficiary turnover was not modeled.
CONCLUSIONS: Stroke imposes a substantial, economic burden on Brazil's public system, with productivity losses in the order of billions of reais compounding direct care costs. The magnitude of this burden and regional cost variationunderscore the value of investment in prevention and timely acute stroke care to curb avoidable costs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH214
Topic
Epidemiology & Public Health, Real World Data & Information Systems
Topic Subcategory
Public Health
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)