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International Stroke Conference 2008 February 20-22 New Orleans, LA

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International Stroke Conference 2008 February 20-22 New Orleans, LA

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  1. Costs and Rehabilitation of Stroke Patients: A Retrospective Study of Medicare BeneficiariesRichard D. Zorowitz, MD 1; Er Chen, MPP 2; Kuo B. Tong, MS 21 Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD; 2 Quorum Consulting, Inc., San Francisco, CA International Stroke Conference 2008 February 20-22 New Orleans, LA

  2. Disclosures The study was funded by Northstar Neuroscience Inc. Dr. Zorowitz is a member of the Northstar Stroke Advisory Board

  3. Background and Rationale • Stroke is the leading cause of adult disability in the US affecting some 750,000 people annually • 50% of survivors with hemiparesis,15-30% left permanently disabled 1,2 • Stroke results in substantial costs to the US health care system • Direct and indirect costs: estimated at $65.5 billion in 2008 3 • Average lifetime cost of ischemic stroke: $140,000 4 • Few studies on long-term stroke outcomes • Patients with hemiparesis were not profiled among overall stroke population • Population-based estimates of prevalence and costs of rehabilitation are lacking 1 Kelley-Hayes M, Beiser A, Kase CS, Scaramucci A, D’Agostino RB, Wolf PA. The influence of gender and age on disability following ischemic stroke: the Framingham study. J Stroke Cerebrovasc Dis. 2003;12:119 –126. 2 Asplund K, Stegmayr B, Peltonen M. From the twentieth to the twenty-first century: a public health perspective on stroke. In: Ginsberg MD, Bogousslavsky J, eds. Cerebrovascular Disease Pathophysiology, Diagnosis, and Management. Vol 2. Malden, Mass: Blackwell Science; 1998:chap 64. 3 Rosamond W, Flegal K, Furie K, et al. Heart Disease and Stroke Statistics_2008 Update. A Report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; DOI: 10.1161/CIRCULATIONAHA.107.187998, e37-e51. 4Taylor TN, Davis PH, Torner JC, Holmes J, Meyer JW, Jacobson MF. Lifetime cost of stroke in the United States. Stroke. 1996;27:1459 –1466.

  4. Objectives Among incident stroke patients, we aim to assess • long-term overall medical costs • utilization of therapy and rehabilitation (TR) and associated costs • the impact of hemiparesis on long-term overall medical costs and TR use and costs

  5. Data Source • 5% randomly selected Medicare beneficiary-level records (Medicare Standard Analytic File) provided by CMS • Demographic information (e.g., age, gender, race) • Clinical characteristics (e.g., diagnosis, vital status) • Medical care services provided across different care settings (e.g., visits, procedures, dates of service) • Costs (i.e., Medicare payments) for each service • Beneficiaries’ data were linked across different claims settings and followed longitudinally from 2003 to 2005

  6. Study Design Index Wash-out window Follow-up window Comorbidities Demographics Mortality, overall Medial costs, utilization of TR and costs Selected pts based on stroke diagnosis (ICD-9-CM code 433.8, 434.01, 434.1, 434.11, and 434.91) and DRG code 14; analyzed demographics for selected pts Q1, 2003 Removed pts if they had any cerebral vascular disease (ICD-9-CM: 430-438); analyzed comorbidity status for selected pts 2002 2003-2005 Stratified pts by the presence of hemiparesis (ICD-9-CM: 438.2); analyzed the patient outcomes

  7. Study Cohort • 2.1 million total beneficiaries • 1.7 million with medical claims 5% Medicare sample in CY2003 Number of pts in each year 2003 2004 2005 Stroke pts survived hospitalization N=2,517 Hemiparesis Cohort 779 605 528 1,849 1,291 1,141 De novo stroke pts N=1,849 Non-Hemiparesis Cohort 1,070 686 613 Source: Centers for Medicare and Medicaid Services (CMS) Standard Analytical File (SAF) 5% Sample

  8. Baseline Characteristics * T-test for Age and chi-square tests for Gender, Race and CCI

  9. Mortality

  10. Medicare Costs Per Patient Costs include hospital inpatient, hospital outpatient, physician care, skilled nursing facility, home health service, durable medical equipment, and hospice services

  11. Medicare Costs by Claim Type OVERALL STROKE PATIENTS

  12. Utilization of Therapy & Rehabilitation

  13. Costs Per Patient of Therapy & Rehabilitation

  14. Costs of Therapy & Rehabilitation by Claim Type OVERALL STROKE PATIENTS

  15. Discussions • Limitations • Serial dependency was expected • Our study did not distinguish stroke-related costs and non-stroke related costs • Diagnosis, resource use and costs were based on patients’ medical claims • Our study did not stratify resource use and costs by stroke sub-type and/or severity • Conclusion • Long-term care and rehabilitation services constituted a significant proportion of the total medical costs • The management of post-stroke patients should consider clinical and economic impacts, esp. costs incurred outside of a hospital inpatient setting

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