OBJECTIVES: The aim of this study was to estimate the economic burden of first-ever acute ischemic stroke (AIS) in the first year of the disease.

METHODS: A retrospective cost of illness study was developed around AIS patients treated in 2019 at the Emergency Clinical Hospital Cluj-Napoca, the only center performing thrombolytic therapy in this county. A mixed approach using new index AIS cases was used to calculate medical (acute care, subacute, and chronic care, neurorehabilitation) and non-medical (morbidity and mortality-related productivity loss, medical leave, state subsidies, overhead) costs, based on a first-year patient pathway. Input information was drawn from openly available resource utilization databases, anonymized hospital records, and additional public sources. Identifying acute ischemic stroke patients was extremely challenging due to both intentional and inadvertent ICD-10 miscoding. Stakeholder consultations and preliminary database queries helped identify codes routinely used for AIS in Romania. Initial results were consolidated with qualitative, string format information present in patient records, using the wildcard term filtering technique of Tableau Prep software. Index stroke selection was based on individual medical histories. Patients who resided outside Cluj County at the time of admission, as well as individuals associated with extreme treatment costs that were not attributable to AIS were were excluded from the main analysis.

RESULTS: A total 782 first-ever AIS cases were identified. The average cost per patient during the first year in 2019 was €7,945 (total cost = €5,4 million), the equivalent of €7.37 per capita, of which 28% medical and 72% non-medical costs. Thrombolysis costed approximately €640 per patient (8% of total cost per patient).

CONCLUSIONS: This is one of the first studies to explore the cost of AIS in Romania. Results should incentivize the development of a national cost of stroke study to support advancements in the country’s rather stagnant reform of Health Technology Assessment.