Abstract
Introduction: Stroke remains one of the leading causes of death worldwide, especially in low- and middle-income countries. According to the Mortality Information System (SIM) in the country made available by DATASUS, and including data on cerebral infarction, ischemic stroke (ischemic stroke), hemorrhagic stroke, subarachnoid hemorrhage, and unspecified stroke, in 2021 there were 103,425 deaths from stroke in Brazil. Objective: to measure the real cost of acute ischemic stroke treatment from the perspective of a tertiary public hospital. Methods: This is a microcosting study (bottom-up approach) of the direct costs of acute ischemic stroke treatment from the perspective of a public hospital (HCFMB). Four scenarios were evaluated: standard treatment only (1); alteplase (2); alteplase and mechanical thrombectomy (3); mechanical thrombectomy (4). The last three scenarios comprise endovascular treatment scenarios. Based on the number of patients hospitalized for acute ischemic stroke at HCFMB in 2019 and the median number of days of hospitalization, direct medical costs from the perspective of HCFMB and SUS were calculated for each scenario. Costs were measured in the SUS Procedures, Medications, Orthoses, Prostheses and Mobility Aids Table Management System (SUS billing) and from the HCFMB direct cost report for 2019 (HCFMB cost). HCFMB costs were adjusted for inflation from 2019 to 2023 through CCEMG – EPPI-Centre Cost Converter. Sensitivity analyses were performed considering the number of eligible participants, incorporation rate, days of hospitalization and frequency of hemorrhage as an adverse event of endovascular treatment. Results: In 2019, 258 patients were hospitalized due to acute ischemic stroke, of which 231 (89.5%) were treated in scenario 1, 21 (8%) in scenario 2, four (1.5%) in scenario 3 and two in scenario 4 (1%). The mean age of patients was 65 years, in all scenarios the male sex predominated, the median number of days of hospitalization was respectively 6, 8, 10 and 9 days. In relation to scenario 1, SUS revenue including ICU daily rates was R$711,449.97, the HCFMB cost was estimated at R$1,523,503.76, generating a difference of - R$812,053.80. Regarding endovascular treatment, the HCFMB cost was estimated at R$438,093.25, and the SUS revenue at R$177,204.8, including the revenue from ICU stays. In an ideal scenario in which endovascular treatment would be offered to 26% of the population with ischemic stroke, the HCFMB cost would increase to R$1,232,868.16, generating a difference between the hospital cost and what is billed by the SUS of - R$1,054,926.20. The variable that most influenced the cost was the number of eligible participants. Discussion and conclusions: The total direct cost of acute ischemic stroke treatment from the HCFMB perspective in 2019, corrected for inflation in 2023, was 2.3 times higher than the SUS revenue, and could reach higher proportions if the ICU stays are not included in the SUS revenue. The variable that most influenced all costs was the number of participants eligible for endovascular treatment.
