Direct medical cost of stroke in Singapore

Background: Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. Aims: To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. Methods: The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. Results: A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P=0·005), subarachnoid hemorrhage (P<0·001) and intracerebral haemorrhage (P<0·001), shorter poststroke period, more than one complications (P=0·045), and a greater number of comorbidities (P=0·001). Conclusion: There is a considerable economic burden associated with stroke in Singapore. The type of stroke, length of poststroke period, and stroke complications and comorbidities are found to be associated with the total costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority.