OBJECTIVES: We aim to assess the economic burden of stroke in patients using Brazil's public healthcare system, with focus on intraparenchymal hemorrhage (IPH) subtypes, including medication-related causes involving direct oral anticoagulants (DOACs) or warfarin.

METHODS: A Markov model was used to simulate lifetime costs after stroke, including direct (hospital admission and readmissions, outpatient visits, rehabilitation, and medication acquisition) 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. Time-driven activity-based costing from 830 Joinvasc patients was used to estimate hospital admissions, outpatient visits, and rehabilitation costs, while medication acquisition and average wages were obtained from nationwide official sources. Costs were reported in 2023 Brazilian Reais (purchasing power parity: U$ 1.00 = R$ 2.66).

RESULTS: The average post-stroke cost was R$ 134,050, with ischemic strokes (IS) slightly costlier (R$ 136,033) than IPH (R$ 126,974) or subarachnoid hemorrhages (R$ 128,168). Direct costs accounted for 31.4% of total costs (IS 31.9%; IPH 19.5%; SAH 27.7%). Among direct costs, the highest was the first hospital admission, contributing to 10.6% of stroke costs (IS 10.5%; IPH 8.1%; SAH 17.8%). Productivity loss represented the largest indirect cost, making up 56.2% of all costs (IS 56.2%; IPH 68.8%; SAH 65.4%). IPH related to DOACs had higher costs (R$ 141,313) compared to warfarin (R$ 128,370), spontaneous lobar (R$ 128,443) or non-lobar strokes (R$ 126,276), with indirect costs making up 75.6%, 80.2%, 77.8%, and 81.8%, respectively.

CONCLUSIONS: Patients and their families bear the bulk of the post-stroke financial burden, with indirect costs comprising 68.6% of all costs. While all stroke types incur substantial costs, IPH subtypes, particularly those with greater severity such as anticoagulant-related, had a higher indirect cost burden.