Background and objectives:

Ischemic stroke is a leading cause of death in Chile, and during the pandemic, emergency care decreased. This study aimed to estimate the economic impact on emergency care drops for ischemic stroke and access to thrombolysis in the Chilean Public Healthcare System during Coronavirus Pandemic.

Methods:

Based on a decision tree model, three cohorts of 1,000 patients were simulated: emergency care with access to thrombolysis (first scenario), and without (second scenario), and no emergency care (third scenario). Each scenario derives into different modified Ranking Scores (mRS) (post-stroke disability). Population included adult public payer beneficiaries (starting age 65 years old). Emergency care decreases were estimated based on real-world databases. Direct costs ($CLP) were calculated from DRG national data and coverage positive lists (annual cycles for acute and chronic care). Indirect long-term care costs were obtained from national data and assigned to mRS from 3 to 5.

Results:

Stroke emergency care decreased 8.6% (min -42%; max +29%) during 2020. Per-patient costs were estimated. For the first scenario: $CLP 10,639,948 (59% direct costs and 41% indirect costs); The second $CLP 10,413,543 (46% direct costs and 54% indirect costs); And the third scenario: $CLP 9,506,897 (41% direct costs and 59% indirect costs). Caregivers in the second and third scenarios that afford long-term care of survivors spend $CLP 4,890,540 yearly. The third scenario, compared against the first, saves the healthcare system $CLP 1,133,052 per case after five years; However, caregivers providing informal care absorb additional financial risks ($CLP 1,292,685) unfunded by the public payer.

Conclusions:

Although, the differences in costs are not substantive between scenarios (maximum difference of 10,65% between the first and third case), the difference in long-term care costs borne by caregivers reaches 30%. Drops in emergency care and access to thrombolysis transferred financial risk to caregivers.