Comparative approaches to estimating lifetime post-stroke costs

Abstract

Introduction: Stroke has a significant impact on health and has risen by 62% among individuals under the age of 45, which mainly represents greater productivity losses. Objectives: To estimate the lifetime direct and indirect financial burden of stroke in Brazil, comparing the estimates obtained through Time-Driven Activity-Based Costing (TDABC) with the reimbursement data for public (DataSUS) and private (TISS) patients. Methods: We developed a Markov model to simulate the lifetime costs associated with stroke. Transition probabilities, the frequency of resource use, and productivity loss were derived from the population-based Joinville Stroke Registry (Joinvasc). The direct costs included medication and healthcare services, while indirect costs covered formal and informal caregiving, nursing home stays, and productivity loss. We assessed healthcare services costs using the TDABC method and compared these with reimbursement values from DataSUS and TISS. The protocol was approved by the Institutional Review Board (53991221.1.0000.5362). Results: Applying TDABC, we estimated the total discounted post-stroke costs to be BRL 96,562. In comparison, total discounted costs estimated using reimbursement values from DataSUS and TISS were BRL 71,498 and BRL 125,569, respectively, showing significant variations (BRL 30,404 with TDABC, BRL 4,378 with DataSUS, and BRL 48,748 with TISS). Indirect costs amounted to BRL 63,588, with productivity loss being the most significant contributor (BRL 59,990). Conclusions: Prioritizing TDABC for costing and analyzing indirect costs is crucial for understanding the stroke’s financial burden in Brazil. The prevalent reliance on healthcare reimbursement data for decision-making might overlook substantial stroke-related costs, potentially limiting access to necessary treatments.