Acute Treatment Costs of Stroke in Brazil
Acute Treatment Costs of Stroke in Brazil
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DOI：
10.1159/000184747
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发表时间：
2009-01-01
影响因子：
5.7
通讯作者：
Massaro, Ayrton
中科院分区：
文献类型：
--
作者：
Christensen, Michael C.;Valiente, Raul;Massaro, Ayrton
背景与目的：虽然中风是巴西的主要死亡原因，但关于中风的急性治疗及其相关费用的信息很少。本研究通过对巴西首次脑出血（ICH）和缺血性卒中（IS）的急性治疗进行临床和经济学表征来解决这一差距。方法：使用来自巴西圣保罗两个高容量卒中中心的数据进行回顾性病历审查。收集2006年1月1日至2007年5月31日期间因首次卒中而入住卒中中心的所有患者的临床和资源利用数据，并通过将适当的单位成本数据分配给所有资源使用来计算每人的平均急性治疗成本。使用2005年购买力平价指数将以巴西雷亚尔计算的费用估计数换算成美元。通过将人均平均费用估计值外推至两种类型卒中的国家发病率数据，估计了突发卒中急性治疗的国家费用。在敏感性分析中检查了全国范围内急性治疗的平均费用。结果如下：共确定了316例卒中患者，并对他们的人口统计学和临床特征、护理模式和结局进行了检查。ICH的平均住院时间为12.0 8 ± 8.8天，IS为13.3 ± 8 23.4天。91%的ICH患者和68%的IS患者入住重症监护室（ICU）。ICH的平均初始住院总费用为4，101美元（SD +/-4，254），IS为1，902美元（SD +/-1，426）。在多变量分析中，出血性卒中、肺炎的发展、神经外科干预、入住ICU和物理治疗都是急性治疗费用的重要独立预测因素。用于ICH事件急性治疗的国家卫生保健总支出为1.224亿美元（范围30.8- 2.742亿美元），用于IS的总支出为3.269亿美元（范围82.4- 7.322亿美元）。结论：在巴西，ICH和IS事件的急性治疗成本很高，主要是由医院治疗强度和院内并发症造成的。随着未来几十年巴西中风发病率的预期增加，这些结果强调了有效预防和急性医疗护理的必要性。版权所有（C）2008 S. Karger AG，巴塞尔
Background and Purpose: Although stroke is the leading cause of death in Brazil, little information exist on the acute treatment provided for stroke and its associated costs. This study addresses this gap by both clinically and economically characterizing the acute treatment of first-ever intracerebral hemorrhage (ICH) and ischemic stroke ( IS) in Brazil. Methods: Retrospective medical chart review using data from two high-volume stroke centers in Sao Paulo, Brazil. Clinical and resource utilization data for all patients admitted to the stroke centers with a first-ever stroke between January 1, 2006 and May 31, 2007 were collected and the mean acute treatment costs per person were calculated by assigning appropriate unit cost data to all resource use. Cost estimates in Brazilian reals (BRL) were converted to US dollars (USD) using the 2005 purchasing power parity index. National costs of acute treatment for incident strokes were estimated by extrapolation of mean cost estimate per person to national incidence data for the two types of stroke. The mean costs of acute treatment on a national scale were examined in sensitivity analysis. Results: A total of 316 stroke patients were identified and their demographic and clinical characteristics, patterns of care, and outcomes were examined. Mean length of hospital stay was 12.0 8 +/- 8.8 days for ICH and 13.3 +/- 8 23.4 days for IS. Ninety-one percent of the ICH patients and 68% of the IS patients were admitted to an intensive care unit (ICU). Mean total costs of initial hospitalization were USD 4,101 (SD +/- 4,254) for ICH and USD 1,902 (SD +/- 1,426) for IS. In multivariate analysis, hemorrhagic stroke, development of pneumonia, neurosurgical intervention, stay in ICU, and physical therapy were all significant independent predictors of acute treatment costs. Aggregate national health care expenditures for acute treatment of incident ICH were USD 122.4 million (range 30.8-274.2) and USD 326.9 million for IS (range 82.4-732.2). Conclusion: Acute treatment costs of incident ICH and IS in Brazil are substantial and primarily driven by the intensity of hospital treatment and in-hospital complications. With the expected increase in the incidence of stroke in Brazil over the coming decades, these results emphasize the need for effective preventive and acute medical care. Copyright (C) 2008 S. Karger AG, Basel