Intracerebral hemorrhage correlates with 'significant' health care costs

Total 1-year costs associated with intracerebral hemorrhage exceeded $120 million per year, according to results of a retrospective cohort study among adult patients in Ontario, Canada that were published in Neurology.

“While morbidity and mortality from intracerebral hemorrhage has been extensively studied, less is known about patient- and health care-associated costs and resource utilization,” the researchers wrote. “An understanding of health care costs, particularly with relation to patient outcomes, is a necessary step in optimization of resource utilization and health care delivery. Patients with intracranial hemorrhage (also including subarachnoid hemorrhage and traumatic hemorrhage) have significant associated in-hospital costs, often a result of prolonged ICU stay.”

Shannon M. Fernando, MD, MSc, a resident in the departments of medicine and emergency medicine at the University of Ottawa, and colleagues aimed to determine the resources used by patients with intracerebral hemorrhage and the related costs in both the short and long term. They also examined the relationship between oral anticoagulation and health care costs.

The researchers collected data on outcomes through health administrative databases and used generalized linear models to determine factors related to total cost. They limited their analysis of oral anticoagulation use to patients aged 66 years and under. Total 1-year direct health care costs in 2020 U.S. dollars served as the primary outcome.

The study included 16,248 individuals with intracerebral hemorrhage (mean age, 71.2 years; 52.3% men). In this group, the 1-year mortality rate was 46% and 24.2% of patients required mechanical ventilation, according to the study results. Median hospital length of stay was 9 days (interquartile range [IQR], 4-20 days). Only 2,290 patients (14.1%) were discharged to home independently, according to the study results; 7,076 patients (34.1%) were discharged to long-term hospital rehabilitation centers and 876 patients (4.2%) were discharged to long-term care.

Fernando and colleagues reported a median total 1-year cost for intracerebral hemorrhage of $26,886 (IQR, $9,641-$62,907). Costs among patients who survived to discharge were much higher ($44,969; IQR, $20,264-$82,414) compared with costs for patients who died in the hospital ($7,268; IQR, $4,031-$14,966). These results were statistically significant, according to the researchers (P < .001). Among patients who survived to discharge, more than half ($26,250) of the $44,969 in total cost per patient was related to costs after hospital discharge, according to the study results.

In their analysis of oral anticoagulant use, Fernando and colleagues found that these agents correlated with higher total 1-year costs (cost ratio, 1.06; 95% CI, 1.01-1.11).

The researchers reported a median inpatient cost per patient of $10,120 (IQR, $5,356-$23,940). Among patients using these services, the median cost per patient was $23,702 (IQR, $6,476-$55,297) for continuing complex outpatient care, $13,835 (IQR, $2,099-$26,811) for long-term care, $23,969 (IQR, $17,096-$31,951) for rehabilitation and $1,294 (IQR, $344-$4,868) for home care, according to the study results.

Fernando and colleagues also examined predictors for 1-year costs. They found that comorbidity burden correlated with increased cost, “suggesting that comorbid patients likely have increased care needs, particularly if they survive to discharge.” A prior intracerebral hemorrhage did not correlate with higher costs among survivors, but prior ischemic stroke did, the researchers noted.

“Our work provides novel data from a complete population regarding the financial burden of [intracerebral hemorrhage], with particular implications for health service administration, and highlights the system-level cost of this devastating condition,” Fernando and colleagues wrote.