The social and economic burden of stroke survivors in Italy: a prospective, incidence-based, multi-centre cost of illness study

Background: The aim of this study was to estimate the one-year societal costs due to a stroke event in Italy and to investigate variables associated with costs in different phases following hospital admission. Methods: The patients were enrolled in 44 hospitals across the country and data on socio-demographic, clinical variables and resource consumption were prospectively surveyed for 411 stroke survivors at admission, discharge and 3, 6 and 12 months post the event. We adopted a micro-costing procedure to identify cost generating components and the attribution of appropriate unit costs for three cost categories: direct healthcare, direct non-healthcare (including informal care costs) and productivity losses. The relation between costs of stroke management and socio-demographic and clinical characteristics as well as disability levels was evaluated in a series of bivariate analyses using non parametric tests (Mann Whitney and Kruskal-Wallis). Multiple linear regression analyses were performed to determine predictors of costs incurred by stroke patients during the acute phase and follow-up of 1 year. Results: On average, one-year healthcare and societal costs amounted to (sic)11,747 and (sic) 19,953 per stroke survivor, respectively. The major cost component of societal costs was informal care accounting for (sic) 6,656 (33.4% of total), followed by the initial hospitalisation, ((sic) 5,573; 27.9% of total), rehabilitation during follow up ((sic) 4,112; 20.6 %), readmissions ((sic) 439) and specialist and general practioner visits ((sic) 326). Mean drug costs per patient over the follow-up period was about (sic) 50 per month. Costs associated to the provision of paid and informal care followed different pattern and were persistent over time (ranging from (sic) 639 to (sic) 597 per month in the first and the second part of the year, respectively). Clinical variables (presence of diabetes mellitus and hemorrhagic stroke) were significant predictors of total healthcare costs while functional outcomes (Barthel Index and Modified Ranking Scale scores) were significantly associated with both healthcare and societal costs at one year. Conclusions: The significant role of informal care in stroke management and different distribution of costs over time suggest that appropriate planning should look at both incident and prevalent stroke cases to forecast health infrastructure needs and more importantly, to assure that stroke patients have adequate "social" support.