University of Oulu

Smeds M, Skrifvars MB, Reinikainen M, et al. One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit. European Stroke Journal. 2022;7(3):267-279.

One-year healthcare costs of patients with spontaneous intracerebral hemorrhage treated in the intensive care unit

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Author: Smeds, Marika1; Skrifvars, Markus B.1; Reinikainen, Matti2;
Organizations: 1Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
2Department of Intensive Care, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
3Department of Intensive Care, Tampere University Hospital and University of Tampere, Tampere, Finland
4Department of Department of Perioperative Services, Intensive Care and Pain Management, Turku University Hospital and University of Turku, Turku, Finland
5Department of Intensive Care, Oulu University Hospital and University of Oulu, Oulu, Finland
6Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
7Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: SAGE Publications, 2022
Publish Date: 2022-09-30


Background: Spontaneous intracerebral hemorrhage (ICH) entails significant mortality and morbidity. Severely ill ICH patients are treated in intensive care units (ICUs), but data on 1-year healthcare costs and patient care cost-effectiveness are lacking.

Methods: Retrospective multi-center study of 959 adult patients treated for spontaneous ICH from 2003 to 2013. The primary outcomes were 12-month mortality or permanent disability, defined as being granted a permanent disability allowance or pension by the Social Insurance Institution by 2016. Total healthcare costs were hospital, rehabilitation, and social security costs within 12 months. A multivariable linear regression of log transformed cost data, adjusting for case mix, was used to assess independent factors associated with costs.

Results: Twelve-month mortality was 45% and 51% of the survivors were disabled at the end of follow-up. The mean 12-month total cost was €49,754, of which rehabilitation, tertiary hospital and social security costs accounted for 45%, 39%, and 16%, respectively. The highest effective cost per independent survivor (ECPIS) was noted among patients aged >70 years with brainstem ICHs, low Glasgow Coma Scale (GCS) scores, larger hematoma volumes, intraventricular hemorrhages, and ICH scores of 3. In multivariable analysis, age, GCS score, and severity of illness were associated independently with 1-year healthcare costs.

Conclusions: Costs associated with ICHs vary between patient groups, and the ECPIS appears highest among patients older than 70 years and those with brainstem ICHs and higher ICH scores. One-third of financial resources were used for patients with favorable outcomes. Further detailed cost-analysis studies for patients with an ICH are required.

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Series: European stroke journal
ISSN: 2396-9873
ISSN-E: 2396-9881
ISSN-L: 2396-9873
Volume: 7
Issue: 3
Pages: 267 - 279
DOI: 10.1177/23969873221094705
Type of Publication: A1 Journal article – refereed
Field of Science: 3126 Surgery, anesthesiology, intensive care, radiology
Funding: This study was supported by grants from Finska Läkaresällskapet, Suomen Lääketieteen Säätiö, Medicinska Understödsföreningen Liv och Hälsa, and a three-year project grant from University of Helsinki (H3702, WBS 73702705). MS received a personal research grant from Finska Läkaresällskapet (the Finnish Medical Association) and Suomen Lääketieteen Säätiö (the Finnish Medical Foundation). RR received personal research grants from Medicinska Understödsföreningen Liv & Hälsa (the Medical Support Foundation Life & Health) and Finska Läkaresällskapet (the Finnish Medical Association).
Copyright information: © European Stroke Organisation 2022. This article is licensed under CC-BY licence (