OBJECTIVES:

Stroke is one of the leading causes of disabilities and death, associated with a high economic burden due to treatment and post-stroke care. This is the first real-world study to estimate the direct cost and indirect cost of the first-ever ischemic stroke and first-year after stroke for patients in China.

METHODS:

This study enrolled surviving patients from the nationally representative database China National Registry Stroke Registry-III (CNSR-III) who were at 18-80 years of age and hospitalized with their first-ever ischemic stroke (the index hospitalization) between 2017/02 and 2018/02. Patient-level demographic data, clinical characteristics (such as modified Rankin Scale (mRS) score, etc.), and outcome data were extracted from CNSR-III. Direct medical costs for the index hospitalization and follow-up hospital visits within one year were obtained from electronic medical records (EMR). Direct non-medical costs, indirect costs, and any additional direct medical costs within one year following the index hospitalization were collected using questionnaires. Total cost as the primary endpoint was calculated by summarizing the direct medical cost, direct non-medical cost, and indirect cost. Descriptive analysis was performed to report cost outcomes. Statistical testing included the Chi-square and the Mann-Whitney U test.

RESULTS:

Overall, 647 patients were included (male: 70.5%; mean age: 61.18±9.97 years; 3-month mRS 0~2: 86.6%; 3~5: 13.4%). The total cost was CNY57,567.48. The direct medical cost was CNY26,612.67, including index hospitalization costs of CNY19,111.39 and CNY8,468.88 in post-stroke medical costs. The indirect cost was CNY28,818.16. The index hospitalization cost for patients with 3-month mRS scores of 3~5 (CNY28331.92) was significantly higher (p<0.001) than that of patients who scored 0~2 (CNY17647.87).

CONCLUSIONS:

The real-world evidence shows the significant economic burden of ischemic stroke in China during the first year following a stroke, mainly driven by indirect costs.