The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy

Emily L Brogan; Joosup Kim; Rohan S Grimley; Sarah J Wallace; Caroline Baker; Tharshanah Thayabaranathan; Nadine E Andrew; Monique F Kilkenny; Erin Godecke; Miranda L Rose; Dominique A Cadilhac

doi:10.1016/j.apmr.2023.01.015

The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy

Arch Phys Med Rehabil. 2023 Jun;104(6):942-949. doi: 10.1016/j.apmr.2023.01.015. Epub 2023 Feb 8.

Authors

Affiliations

¹ School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Sir Charles Gairdner Hospital, Nedlands, Perth, Australia.
² Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia.
³ Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Griffith University, Queensland, Australia.
⁴ Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Queensland, Australia.
⁵ Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Speech Pathology Department, Monash Health, Melbourne, Victoria, Australia.
⁶ Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
⁷ The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
⁸ Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia.
⁹ Centre of Research Excellence in Aphasia Rehabilitation Recovery, La Trobe University, Bundoora, Victoria, Australia; Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia; The Centre of Research Excellence in Stroke Rehabilitation, Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia; Stroke Division, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Victoria, Australia. Electronic address: dominique.cadilhac@monash.edu.

PMID: 36758711
DOI: 10.1016/j.apmr.2023.01.015

Abstract

Objective: To describe the costs of hospital care for acute stroke for patients with aphasia or dysarthria.

Design: Observational study from the Stroke123 project.

Setting: Data from patients admitted with stroke (2009-2013) from 22 hospitals in Queensland participating in the Australian Stroke Clinical Registry (AuSCR) were linked to administrative datasets.

Participants: Communication impairments were identified using International Classification of Diseases, 10th Revision, Australian Modification codes. Overall, 1043 of 4195 (25%) patients were identified with aphasia (49% were women; median age 78 years; 83% with ischemic stroke), and 1005 (24%) with dysarthria (42% were women; median age 76 years; 85% with ischemic stroke).

Interventions: Not applicable.

Main outcome measures: Linked patient-level, hospital clinical costing related to the stroke, were adjusted to 2013/2014 Australian dollars (AU$, US$ conversion x 0.691) using recommended national price indices and multivariable regression analysis with clustering by hospital performed.

Results: Compared with patients without aphasia, the median hospital costs/patient were greater for those with aphasia for medical (aphasia AU$2273 vs AU$1727, P<.001), nursing (aphasia AU$3829 vs AU$2748, P<.001) and allied health services (aphasia AU$1138 vs AU$720, P<.001). Similarly, costs were greater for patients with dysarthria compared with those without dysarthria. Adjusted median total costs were AU$2882 greater for patients with aphasia compared with patients without aphasia (95% confidence interval, AU$1880-3884), and AU$843 greater for patients with dysarthria compared with those without dysarthria (95% confidence interval, AU$-301 to 1987).

Conclusions: People with communication impairment after stroke incur greater hospital costs, in particular for medical, allied health, and nursing resources.

Keywords: Aphasia; Cost analysis; Data linkage, Dysarthria; Rehabilitation; Stroke.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aphasia* / etiology
Australia
Communication
Communication Disorders* / etiology
Dysarthria / etiology
Female
Hospitalization
Humans
Ischemic Stroke*
Male
Stroke* / complications