Abstract TP337: Variation in Total and Daily Relative Costs of Stroke Hospitalization by Departments

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Intro: Stroke is a major public health burden, but few data are available on the distribution of relative inpatient stroke costs. We determined key drivers of cost in patients hospitalized with ischemic stroke (IS) to inform decisions regarding optimal resource use.

Methods: We linked 1,578 IS patients in our local Get with the Guidelines Stroke database (2010- 2013) to administrative, cost accounting data (EPSI, inc). Relative hospital costs by department within 30 days post admission were stratified by quartiles into very high (n=394), high (n=395), low (n=394) and very low (n=395). We analyzed mean daily relative cost per patient, stratified by mortality. All financial data are relative costs, reported as medians [IQR] multiplied by a constant.

Results: The median overall relative cost was $274 (IQR $183-$525) per admission. In the very high cost group, ICU nursing, nursing and operating room were the top three cost areas and accounted for 64% of all IS costs (Figure 1). The highest relative mean daily costs occurred during the first two inpatient days, and were 40.4% and 27.1% higher respectively for patients dying during the index admission than survivors (p<0.0001) (Figure 2).

Conclusions: Inpatient IS costs vary widely, and patients in the highest cost quartile account for a majority of overall costs. The greatest per day costs occur in the first few days of care, regardless of survival. Improvements in major cost drivers, including use of bed days (and associated nursing costs), radiology and pharmacy may be possible. These findings should be validated at other medical centers in different cost accounting software systems.

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