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Session: Cost of Illness
Room: Meeting Rooms 25+26
Time: Thu 16:00-17:15

Presenter: Samantha Smith (Economic & Social Research Institute. Health Research & Information Division)

Abstract

This paper estimates the economic burden of stroke and transient cerebral ischaemic attacks (TIA) in Ireland.

Stroke is a leading cause of death and disability worldwide. Patients who survive an acute stroke episode are often left with some degree of disability and many become dependent on care givers. With a high mortality and disability burden, the economic cost of stroke is also expected to be high. It is estimated that cerebrovascular diseases account for 2-5% of total health care costs in industrialized countries. In Ireland, stroke accounts for 7.4% of mortality and a recent audit of stroke care identified the need for a radical and urgent review of stroke services. However, there has been limited investigation of the costs of stroke in Ireland. In a recent European cost of illness study, estimates of the cost of stroke in Ireland were based on non-Irish epidemiological and cost data. There have been no estimates of the cost of TIA in Ireland.

This paper estimates the total economic burden of stroke and TIA in Ireland in the year 2007, using Irish data. Epidemiological data are drawn from a detailed study of stroke/TIA incidence in the North Dublin area, and from available survey evidence on stroke prevalence. Direct costs of stroke are estimated for acute hospital care, in-patient rehabilitation, community rehabilitation, drugs, nursing home care, general practitioner care and specialist out-patient care. Other direct costs include aids, appliances and home modifications for stroke patients living at home, and expenditure on stroke services by voluntary agencies. Indirect costs include the value of productivity foregone due to informal care for stroke patients living in the community, stroke morbidity and mortality. Direct costs of TIA are estimated for acute hospital care, in-patient rehabilitation, and drugs.

Sensitivity analysis examines the impact on total costs of alternative estimates of incidence and prevalence, and of adjustments in unit costs. Stroke/TIA services are financed by a mix of public and private resources and the distributional burden of costs across the different sources is assessed.

Results indicate that the total economic burden of stroke and TIA in Ireland is in line with other countries. Total direct stroke costs are estimated to account for approx. 2-4% of total health expenditure, consistent with the international literature. Stroke-related medications account for a smaller proportion of total stroke costs in Ireland than in other countries. The emphasis in this paper on medications taken specifically for stroke (i.e. controlling for medications taken pre-stroke) contributes to this difference. Approximately 20% of stroke costs are financed from private resources, and this is discussed in the context of wider issues about the structure of health care financing in Ireland.

Key Terms

cost of illness, stroke, TIA, Ireland, economic burden

Authors:

Samantha Smith (Economic & Social Research Institute. Health Research & Information Division)

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