OBJECTIVES: To estimate the lifetime direct and indirect financial stroke burden in Brazil, comparing time-driven activity-based costing (TDABC), and reimbursement data of public (DataSUS) and private (TISS) patients.

METHODS: A Markov model simulated lifetime costs, including healthcare services (hospital admission and readmissions, outpatient visits, rehabilitation), medication, and indirect costs (formal and informal caregiving, nursing home stays, and productivity loss). Transition probabilities and resource use derived from 8,231 patients in the population-based Joinville Stroke Registry (Joinvasc), which also provided data on pre and pos-stroke employment. We obtained medication acquisition costs and average wages from nationwide official sources. TDABC including 830 public healthcare patients estimated average costs of hospital admissions, outpatient visits and rehabilitation. Healthcare services reimbursement were calculated from DataSUS and TISS, nationwide reimbursement databases for public and private healthcare, respectively. Results were reported in 2023 Brazilian Reais (purchasing power parity U$ 1.00 = R$ 2.66).

RESULTS: By applying TDABC, we estimated total post-stroke costs to be R$ 134,050. With reimbursement values using DataSUS and TISS, costs would be estimated at R$ 101,175, and R$ 155,246, respectively. These methods varied in cost estimates for hospital admissions (R$ 25,646, R$ 4,424, R$ 49,627), outpatient visits (R$ 6,993, R$ 640, R$ 6,458), and rehabilitation (R$ 5,575, R$ 275, R$ 3,326), leading to significant disparities in the total costs of healthcare services (R$ 38,214, R$ 5,339, R$ 59,410). Indirect costs were R$ 92,007, which comprised productivity loss (R$ 76,750), formal caregiving (R$ 9,809), nursing home stays (R$ 4,569), and informal caregiving (R$ 879). Costs with anticoagulants and antiplatelets totaled R$ 3,829.

CONCLUSIONS: The TDABC approach uncovers true costs of stroke care, indicating substantial underfunding in the public healthcare sector which limits access to effective stroke care. Furthermore, indirect costs were considerable and underscore the importance of prevention and treatment strategies to mitigate stroke burden.