Sains Malaysiana 51(12)(2022): 4175-4184

http://doi.org/10.17576/jsm-2022-5112-24

Estimation of Medical Costs for Ischemic Stroke Patients - From the Perspective of a Health Care Provider

(Penganggaran Kos Perubatan Bagi Pesakit Strok Iskemia - Daripada Perspektif Pemberi Perkhidmatan Kesihatan)

NORIZA MAJID^1,*, CHEW YEE LIN¹ & AZIMATUN NOOR AIZUDDIN²

¹Department of Mathematical Sciences, Faculty of Science and Technology, Universiti Kebangsaan Malaysia, 43600 UKM Bangi, Selangor Darul Ehsan, Malaysia

²International Casemix & Clinical Coding Center, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, 56000 Kuala Lumpur, Federal Territory, Malaysia

Diserahkan: 6 April 2022/Diterima: 26 Ogos 2022

Abstract

The increasing prevalence of stroke has presented challenges to all countries. Since 2007, stroke has been one of the leading causes of death in Malaysia. Furthermore, the number of strokes is expected to increase steadily. Certainly, all parties are concerned, particularly considering the socioeconomic burden that must be borne. As a result, the community and health-care providers must measure the number required to cover the medical expenses associated with a stroke. The estimated medical costs are based on the medical costs of ischemic stroke patients treated at Hospital Canselor Tuanku Mukhriz, which involved a total of 2161 stroke patients between 2016 and 2020. Demographic factors such as age and gender, as well as clinical factors such as severity, length of stay (LOS), and comorbid factors, were used to determine the medical costs of ischemic stroke patients. A logarithmic transformation was carried out on the medical cost to create a more suitable medical cost estimating model, considering the skewed nature of the medical cost data of ischemic stroke patients. As a result of the multiple linear regression analysis, age, LOS, severity level, type of comorbidity such as hypertension, ischemic heart disease (IHD), atrial fibrillation (AF), smoking and alcohol habits were found to have a significant effect on these medical costs. However, a patient's medical costs are unaffected by gender or type of comorbidity, such as diabetes or hyperlipidemia. Furthermore, it was discovered that increased LOS, severity levels, or the presence of comorbidities such as IHD, AF, and smoking habits all increased patients' medical costs. Medical costs, on the other hand, were found to be lower in patients who were older, consumed alcohol, and had hypertension.

Keywords: Ischemic stroke; medical cost; regression analysis

Abstrak

Peningkatan prevalens strok telah memberikan cabaran kepada semua negara. Sejak 2007, strok telah menjadi satu daripada punca utama kematian di Malaysia. Tambahan pula, bilangan strok dijangka akan terus meningkat. Pastinya ini menimbulkan kebimbangan kepada semua pihak terutama apabila memikirkan beban sosioekonomi yang perlu ditanggung. Justeru, masyarakat dan pihak pemberi perkhidmatan kesihatan perlu mengetahui amaun bagi membiayai kos perubatan bagi penyakit strok ini. Anggaran kos perubatan dibuat berdasarkan kos perubatan pesakit strok iskemia yang dirawat di Hospital Canselor Tuanku Mukhriz yang melibatkan seramai 2161 pesakit strok dari tahun 2016 sehingga 2020. Faktor demografi seperti umur dan jantina, serta faktor klinikal seperti tahap ketenatan, tempoh tinggal (LOS) dan faktor komorbid, digunakan untuk menentukan kos perubatan pesakit strok iskemia. Transformasi logaritma telah dilakukan ke atas kos perubatan untuk mendapatkan model anggaran kos perubatan yang lebih sesuai dengan mengambil kira kepencongan data kos perubatan pesakit strok iskemia. Hasil daripada analisis regresi linear berganda yang dilakukan, umur, LOS, tahap ketenatan, jenis komorbid seperti hipertensi, penyakit jantung iskemia (IHD), fibrilasi atrium (AF), tabiat merokok dan pengambilan alkohol didapati mempunyai kesan yang signifikan ke atas kos perubatan. Walau bagaimanapun, jantina dan jenis komorbiditi iaitu diabetes dan hiperlipidemia, tidak memberi kesan kepada kos perubatan pesakit. Selain itu, didapati bahawa peningkatan dalam LOS, tahap ketenatan, kehadiran komorbiditi seperti IHD, AF dan tabiat merokok didapati mengakibatkan peningkatan dalam kos perubatan pesakit. Kos perubatan, sebaliknya didapati lebih rendah bagi pesakit yang lebih tua, mengambil alkohol dan mempunyai hipertensi.

Kata kunci: Analisis regresi; kos perubatan; strok iskemia

RUJUKAN

Abdo, R.R., Abboud, H.M., Salameh, P.G., Jomaa, N.A., Rizk, R.G. & Hosseini, H.H. 2018. Direct medical cost of hospitalization for acute stroke in Lebanon: A prospective incidence-based multicenter cost-of-illness study. The Journal of Health Care Organization, Provision, and Financing doi:10.1177/00 46958018792975.

Cheah, W.K., Hor, C.P., Zariah, A.A. & Looi, I. 2016. A review of stroke research in Malaysia from 2000 - 2014. Med. J. Malaysia 71(Suppl 1): 58-69.

Chow, W.L., Aung, S.T. & Meyyappan, A. 2010. Factors influencing costs of inpatient ischaemic stroke care in Singapore. Proceedings of Singapore Healthcare 19(4): 283-291.

Evers, S.M.A.A., Struijs, J.N., Amend, A.J.H.A., van Genugten, M.L.L., Jager, J.H.C. & van den Bos, G.A.M. 2004. International comparison of stroke cost studies. Stroke 35(5): 1209-1215. doi: 10.1161/01.STR.0000125860.48180.48

Fattore, G., Torbica, A. & Susi, A. 2012. The social and economic burden of stroke survivors in Italy: A prospective, incidence-based, multi-centre cost of illness study. BMC Neurol. 12: 137. https://doi.org/10.1186/1471-2377-12-137

Feigin, V.L., Forouzanfar, M.H. & Krishnamurthi, R. 2014. Global and regional burden of stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet 383: 245-254.

Foreman, K.J., Marquez, N. & Dolgert, A. 2018. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: Reference and alternative scenarios for 2016-40 for 195 countries and territories. The Lancet 392(10159): 2052-2090.

Go, A.S., Mozaffarian, D., Roger, V.L. & American Heart Association Statistics Committee and Stroke Statistics Subcommittee. 2014. Heart disease and stroke statistics - 2014 update: A report from the American Heart Association. Circulation 129(3): e28-e292.

Jorgensen, H.S., Nakayama, H. & Raaschou, H.O. 1997. Acute stroke care and rehabilitation: An analysis of the direct cost and its clinical and social determinants. The Copenhagen stroke study. Stroke 28: 1138-1141.

Laloux, P. & Belgian Stroke Council. 2003. Cost of Acute Stroke. A review. Acta Neurol. Belg. 103(2): 71-77.

Loo, K.W. & Gan, S.H. 2012. Burden of stroke in Malaysia. International Journal of Stroke 7(2): 165-167. doi: 10.1111/j.1747-4949.2011.00767.x

Mamoli, A., Censori, B., Casto, L., Sileo, C., Cesana, B. & Camerlingo, M. 1999. An analysis of the costs of ischemic stroke in an Italian stroke unit. Neurology 53(1): 112-116.

Mohd Nordin, N.A., Aljunid, S.M., Abdul Aziz, A.F., Muhammad Nur, A. & Sulong, S. 2012. Direct medical cost of stroke: Findings from a Tertiary Hospital in Malaysia. Med. J. Malaysia 67(5): 473-477.

Reckelhoff, J.F. 2001. Gender differences in the regulation of blood pressure. Hypertension 37(5): 1199-1208. doi:10.1161/01.hyp.37.5.1199

Reed, S.D., Blough, D.K., Meyer, K. & Jarvik, J.G. 2001. Inpatient costs, length of stay, and mortality for cerebrovascular events in community hospitals. Neurology 57(2): 305-314.

Reilly, M.R. & McCullough, L.D. 2018. Age and sex are critical factors in ischemic stroke pathology. Endocrinology 159(8): 3120-3131. https://doi.org/10.1210/en.2018-00465

Rost, N.S., Bottle, A., Lee, J.M. & Randall, M. 2016. Stroke severity is a crucial predictor of outcome: An international prospective validation study. Journal of the American Heart Association 5: e002433. https://doi.org/10.1161/JAHA.115.002433

Shahathevan, R., Yahya, W.N.N.W., Jan, T.H. & Ibrahim, N.M. 2013. Stroke care in Pusat Perubatan UKM; The actual picture. Med. J. Malaysia 68(2): 187-188.

Strong, K., Mathers, C. & Bonita, R. 2007. Preventing stroke: Saving lives around the world. Lancet. Neurol. 6(2): 182-187. doi: 10.1016/S1474-4422(07)70031-5

Walter, P., Wodchis, R., Bhatia, S. & Leblanc, K. 2012. A review of the cost of atrial fibrillation. Value in Health 15(2): 240-248, https://doi.org/10.1016/ j.jval.2011.09.009

Wang, G., Zhang, Z., Ayala, C., Dunet, D.O., Fang, J. & George, M.G. 2014. Costs of hospitalization for stroke patients aged 18-64 years in the United States. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association 23(5): 861-868. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.07

Yoneda, Y., Uehara, T., Yamasaki, H., Kita, Y., Tabuchi, M. & Mori, E. 2003. Hospital-based study of the care and cost of acute ischemic stroke in Japan. Stroke 34(3): 718-724. doi: 10.1161/01.STR.0000056171.55342.FF

Zhu, D., Shi, X.F., Nicholas, S., Chen, S., Ding, R., Huang, L., Ma, Y. & He, P. 2020. Medical service utilization and direct medical cost of stroke in Urban China. International Journal of Health Policy and Management 11(3): 277-286. doi:10.34172/ijhpm.2 020.111

*Pengarang untuk surat-menyurat; email: nm@ukm.edu.my