Modified Rankin Scale as a Determinant of Direct Medical Costs after Stroke

Dewilde , Sarah Annemans, Lieven Peeters, André [UCL] Hemelsoet, Dimitri Vandermeeren, Yves [UCL] Desfontaines, Philippe Brouns, Raf Vanhooren, Geert Cras, Patrick Michielsens, Boudewijn Redondo, Patricia Thijs, Vincent et al.[show all]

Background Resource use in the acute and subacute phases after stroke depends on the degree of disability. Aims To determine if direct costs after stroke also vary by level of disability as measured using the modified Rankin scale (mRS) at the chronic stage after stroke. Methods In a multicentre study, we collected acute and chronic in- and outpatient resource use in survivors of ischemic stroke stratified by levels of disability according to the mRS. Statistical inference on costs at each level of the mRS was estimated using a General Linear Model for the first 3 months, the first year and any subsequent year after ischemic stroke. Results A total of 569 survivors of ischemic stroke with a mean age of 71.7 years were enrolled (41% female) from 10 academic and non-academic centres. Costs varied substantially over time and with each mRS level. The total average costs in the first year were estimated $33,147 per patient, ranging from $9,114 for mRS 0 to $83,236 for mRS 5. In the second year, medical costs were on average $14,039, varying from $2,921 to $39,723 for patients with mRS 0 to 5. The level of disability based on the mRS was a major determinant of resource use, irrespective of age, gender, atrial fibrillation and vascular risk factors. Conclusion Long-term resource use after stroke is high and is mainly driven by degree of disability as measured by the mRS.