In-hospital direct cost of acute ischemic and hemorrhagic stroke in Greece

Objectives - The geographic inequity and the wide variation in the patterns of care of stroke found across Europe together with the lack of health economics evaluation in Greece led to this prospective study, aiming to provide data on in-hospital direct cost of patients with an acute stroke in Greece, and to identify independent prognostic factors. Methods - Demographic and clinical data were recorded on 429 consecutive patients with an acute ischemic or hemorrhagic stroke admitted to a tertiary care hospital in Greece during a period of 18 months. The costs incurred were estimated using the official financial charts listing in euro (sic), the real expenditure of all hospital departments. Results - The direct in-hospital cost for all stroke cases was 1,551,445(sic) for a total of 4674 days (331.9(sic) per day in-hospital). The mean in-hospital cost per stroke patient was 3624.9(sic) (+/- 2695.4). Hemorrhagic strokes were significantly more expensive than the ischemic strokes [mean 5305.4 (+/- 4204.8)(sic) and 3214.5 (+/- 1976.2)(sic), respectively) and lacunar strokes the least expensive among ischemic stroke subtypes. The length of stay was highly correlated with in-hospital total cost. Multivariate linear regression analysis showed that admission ward, stroke severity on admission, stroke type and status discharge were independent predictors of cost. Conclusions - Purchasers in our health services should differentiate in their cost estimates and pricing schemes between types of cerebrovascular events. Future studies should focus on modifiable factors related, not only with stroke characteristics, but also with operational policies of hospitals, that may influence length of stay.