Cost of a recurrent vs. cost of first-ever stroke over an 18-month period

When assessing the cost-effectiveness of the secondary prevention of stroke, it is not well known whether the cost of a recurrent brain infarction (BI) is different from a first-ever BI. In a cohort of 435 consecutive prevalent cases of BI (including both recurrent and first-ever BI) we collected medical and socio-economic variables. Handicap was measured with the Rankin scale. Only the direct medical costs were considered over an 18-month period from a societal perspective. We compared first-ever to recurrent BI. Of the 435 patients 20.5% had a recurrent BI. The length of the initial hospitalization and the distribution of the patients into the three classes of handicap (Rankin 0-2, 3, and 4-5) were similar in the first-ever and recurrent BI groups. The average total cost of a first-ever BI was e19 725 (95% CI, 17 950-21 501) and e18 560 (95% CI, 15 798-21 322) for a recurrent BI (P = 0.48). There were no differences between the two groups when the costs were compared by handicap levels (P = 0.17) or when the costs were compared for each type of expenditure (initial hospitalization, rehabilitation, ambulatory services) except for long-term care, because of the small number of cases. This study suggests that the costs of recurrent BI are roughly similar to the costs of first-ever BI, which may be helpful when studying the cost-effectiveness of secondary stroke prevention trials.