Contrary to older research that showed neuroimaging emerging as the single most dominating cost contributor in ischemic stroke care for older Americans, a new study shows treatment and other line items account for bigger slices of the bill.
Eric Christensen, PhD, of the Harvey L. Neiman Health Policy Institute and colleagues made the finding after analyzing Medicare claims data for more than 75,000 consecutive hospitalizations of patients 65 and older who suffered ischemic stroke between 2012 and 2019.
JACR published the study Nov. 7 [1].
More Treatment, Higher Costs
The team reports that, over the study period, the median cost of care for ischemic stroke per episode rose by 4.9% (from $9,509 in 2012 to $9,973 in 2019).
The main driver of the rising expense trajectory was a 155% increase in the ratio of episodes that involved treatment, the authors show.
Other key findings:
- The strongest odds of having a hospitalization costing more than $20,000 attached to cases in which treatment included endovascular thrombectomy or, with a lesser effect, intravenous thrombolysis.
- Also associated with high-cost care episodes were in-hospital deaths and lengths of stay greater than four days.
- Cases that included neuroimaging with CT angiography, CT perfusion and/or MR angiography were indeed associated with high-cost episodes.
Questions Raised About Assumptions in Stroke Care
In their discussion, Christensen and co-authors underscore that, despite neuroimaging’s growing utilization for ischemic stroke over the study period, this increase did not overshadow other sources of overall rising costs.
They also emphasize their finding that the trend of increasing treatment costs for ischemic stroke have been offset, at least in part, by drops in median length of stay and in-hospital mortality.
In addition, the researchers note, growth in median hospital cost for ischemic stroke has been less than per capita growth in national health expenditures—despite rising treatment rates.
“This raises questions about the assumptions used in the projections of future stroke care costs,” Christensen et al. remark.
More:
Investigators should examine how the combination of recent trends in treatment, neuroimaging, length of stay, mortality, and stroke severity, and the association of these trends with costs, may affect projected stroke costs. Additionally, future research should examine how the neuroimaging and treatment trends have affected patient-borne costs for ischemic stroke. Finally, future research should examine the value of improved ischemic stroke outcomes that can be associated with increased treatment and neuroimaging relative to their costs.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.