Stroke-associated medical costs

Hello to all our friends in the US! This post is for you, especially if you are fence-sitting on the debate over universal health care in your country.

A close personal relative of mine had a stroke last month. This stroke was caused by a blood clot in the brain, and resulted in pretty severe aphasia, which the person is still recovering from. Luckily, the stroke was caught early enough that it could be targetted by clot-busting medicines, and as a result, the patient has recovered quite a bit from the initial onset. The patient was kept in hospital in the stroke ward for two weeks, and then was kept in a rehabilitation facility for two more weeks while recovering vocal and comprehension skills. The patient was recently released from rehab, but will have several follow-up visits with a family doctor, neurologists, occupation therapists, and speech therapists. The patient has been prescribed a series of new drugs, as well as continuing drug treatment for an unrelated condition. They will also need a degree of home care, provided both by the family and at a cost by professionals.

Now that a month has passed since the initial stroke, I’ve had some time to contemplate. I thought to myself, what would’ve happened if this stroke occured absent a comprehensive government health system? Would the response team have been so quick to get the patient a CT scan and determine that a clot-buster (tPA) was the most effective acute treatment, or would they have to wait to call an insurance agent first? Would the treatment even be considered if the patient had no insurance? Would the patient even survive this event without the tPA? If so, how much more diminished would the patient’s quality of life be? A lot of what-ifs.

I digress. The main thrust of this post is meant to be the cost of treatment. The total costs that we’ve incurred for the stroke here in Nova Scotia includes the following (so far):

Immediate costs:
Ambulance response: $134.52
Acute care cost: $0
Hospital fees: $250 (for in-room TV hook-up, which is not covered provincially)

Continuing costs:
Co-pay drugs: $30/month
Other drugs, not covered by Pharmacare: $90/month
Homecare costs: unknown, but capped at $224.19/month based on the individual’s income and status

Total costs of the stroke over five years, assuming annual 2.67% interest on the above costs, and no reduction in drug or home-care costs: $22,169

Searching for stroke costs in the US, I turned up this analysis, on the American Heart Association website: Lifetime Cost of Stroke in the United States . The authors developed models that estimate the lifetime costs of strokes based on the age of the patient and the type of stroke suffered. It’s important to note that all of the strokes from their studies occured in 1990. The stroke I’m comparing to occured in 2009, and I’m not sure if tPAs were available for treatment of strokes caused by blood clots back in 1990. At any rate, the cost associated with stroke calculated by the researchers for the same category of stroke and age as the patient in my sphere, minus the costs of control subjects is (I’m using 1.166799 as the exchange rate between US and Canadian dollars in 1990):

Direct costs, year 1: US$14,998 = CAD$17450
Direct costs, year 2: US$3,295 = CAD$3845
Pharmaceuticals (annually): US$355 = CAD$414
Long-term costs (annually): US$4918 = CAD$5738

So, the total equivalent cost over five years in 1990 dollars would be $52055. Inflation since 1990 has averaged 2.67%, so in 2009 dollars that cost rises to $85880.

Yikes. Four times the cost! Our system obviously isn’t perfect (I’d like to see ambulatory services covered, pharmacare covered 100%, and homecare costs covered if prescribed by a doctor), but $60,000 is a lot of change, especially when the illness in question prevents the patient from working and earning at their previous income level. Unless the patient were covered by an insurance plan, and the insurer honoured the claim (which we all know doesn’t always happen).

Edit: Actually, I’ve seriously underestimated the annual rate of inflation for medical costs in the USA. According to Tom’s Inflation Calculator, medical inflation since 1990 would bring the actual 2009 costs up to $126,792. Double yikes. Something tells me that I’m still underestimating the cost of a 2009 hospital admission, 28-day hospital stay, ER drug charges, and diagnostic charges, but I’m only trying to ball-park the figures. Consider $126,792 a bare minimum that an uninsured patient would be paying.