Document Type : Original Article
Authors
1 Student Research Committee, School of Medicine, Arak University of Medical Sciences, Arak, Iran
2 Department of Neurology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
3 Department of Epidemiology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
Abstract
Background: Stroke claims about 5.5 million lives annually, making it the second leading cause of death worldwide. In the United States (US), it is the fifth leading cause, trailing behind cardiovascular diseases (CVD) and cancer.
Methods: This retrospective cohort study conducted at Valiasr Hospital in Arak City, Iran, focused on patients with stroke registered in Arak University of Medical Sciences. 153 patients were examined. Data on demographics, stroke types, financial items, and National Institutes of Health Stroke Scale (NIHSS), Barthel, and modified Rankin Scale (mRS) scores were collected. NIHSS, mRS, and Barthel scales were used to assess economical findings of hospitalization and the first trimester after discharge in private and governmental health settings. Data were analyzed through SPSS software for statistical analysis.
Results: The study involved patients with a mean age of 69.53 [standard deviation (SD) = 13.4] years, who were hospitalized for about 4.97 days. Gender distribution was with women at 51% and men at 49%. After discharge, a significant majority (66%) received care exclusively from private settings, while 34% utilized both private and governmental services. In contrast, governmental settings showed no significant differences in costs related to NIHSS scores (P = 0.120). Similarly, Barthel scores indicated notable cost disparities in private settings at all stages (P = 0.0001), while governmental settings exhibited no significant differences post-discharge (P = 0.777).
Conclusion: Our study reveals that patients primarily rely on private settings for post-discharge services, with costs largely borne by themselves. The financial burden of hospitalization is mostly covered by basic insurance.
Keywords
- Stroke
- Hospitalization
- Patient discharge
- Economics
- Hospital
- Patient
- Disease
- Burden
- Chronic Disease
- Medicine
Main Subjects
- Montazer SH, Hosseininejad SM, Bozorgi F, Assadi T, Hashemi SN, Lotfipour M, et al. Epidemiology of Injuries Caused By Motor Accidents in Patients Referred To Emergency Department of A Trauma Center Hospital in North of Iran. J Emerg Health Care 2019; 8(1): 10-8.
- Mensing LA, Kappelle LJ, Koffijberg H, Ruigrok YM. Drivers of healthcare costs in patients with ischaemic stroke: A hospital-based retrospective cohort study. BMJ Open 2023; 13(1): e064445.
- Świtalski J, Wnuk K, Tatara T, Miazga W, Wiśniewska E, Banaś T, et al. Interventions to Increase Patient Safety in Long-Term Care Facilities-Umbrella Review. Int J Environ Res Public Health 2022; 19(22).
- Strilciuc S, Grad DA, Radu C, Chira D, Stan A, Ungureanu M, et al. The economic burden of stroke: a systematic review of cost of illness studies. J Med Life 2021; 14(5): 606-19.
- Talebi HM, Javaheri J, Fakhari MS. Successful treatment of a high-risk diabetic foot ulcer by ozone therapy and collagen powder: A case report. Clin Case Rep 2024; 12(4): e8728.
- Tan E, Gao L, Collier JM, Ellery F, Dewey HM, Bernhardt J, et al. The economic and health burden of stroke among younger adults in Australia from a societal perspective. BMC Public Health 2022; 22(1): 218.
- Fakhari MS, Poorsaadat L, Almasi-Hashiani A, Ebrahimi-Monfared M. Inflammatory markers and functional outcome score in different subgroups of ischaemic stroke: A prospective cohort study. BMJ Neurol Open 2024; 6(1): e000556.
- Dey G, Ramesh J, K G. Cost effectiveness analysis in the management of stroke in a tertiary care hospital. Int J Basic Clin Pharmacol 2019; 8(11): 2566-9.
- Fakhari MS, Poorsaadat L, Mohammad Talebi H, Kosari F. Stiff-person syndrome revealing an occult gray zone lymphoma: A diagnostic challenge. Clin Case Rep 2023; 11(12): e8328.
- Li C, Baek J, Sanchez BN, Morgenstern LB, Lisabeth LD. Temporal trends in age at ischemic stroke onset by ethnicity. Ann Epidemiol 2018; 28(10): 686-90.e2.
- Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Age at stroke: Temporal trends in stroke incidence in a large, biracial population. Neurology 2012; 79(17): 1781-7.
- Chong JY, Sacco RL. Risk factors for stroke, assessing risk, and the mass and high-risk approaches for stroke prevention. CONTIN: Lifelong Learn Neurol 2005; 11(4): 18-34.
- Kavanagh S, Knapp M, Patel A. Costs and disability among stroke patients. J Public Health Med 1999; 21(4): 385-94.
- Mu F, Hurley D, Betts KA, Messali AJ, Paschoalin M, Kelley C, et al. Real-world costs of ischemic stroke by discharge status. Curr Med Res Opin 2017; 33(2): 371-8.
- Caro JJ, Huybrechts KF, Kelley HE. Predicting treatment costs after acute ischemic stroke on the basis of patient characteristics at presentation and early dysfunction. Stroke 2001; 32(1): 100-6.
- Angerova Y, Marsalek P, Chmelova I, Gueye T, Uherek S, Briza J, et al. Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: The Czech Republic perspective. Int J Rehabil Res 2020; 43(4): 376-82.
- Silva GS, Miranda-Alves M. Challenges in the Management of Stroke in Intensive Care Units in Low- and Middle-Income Countries. Neurocrit Care 2025; 43(3): 1069-77.
- Nepal G, Yadav JK, Lamsal S, Ojha R. Pragmatic strategies for improving prevention, diagnosis, and treatment of epilepsy in low- and middle-income countries. Epilepsy Res 2025; 215: 107586.
- Jamalabadi S, Winter V, Schreyögg J. A Systematic Review of the Association between Hospital Cost/price and the Quality of Care. Appl Health Econ Health Policy 2020; 18(5): 625-39.
- Xu J, Zhao M, Vrosgou A, Yu NCW, Liu C, Zhang H, et al. Barriers to medication adherence in a rural-urban dual economy: A multi-stakeholder qualitative study. BMC Health Serv Res 2021; 21(1): 799.
)