Journal of Neurological Sciences (Turkish) 2016 , Vol 33 , Num 3
Real World Data Estimation: Management and Cost-analysis of Stroke in Tertiary Hospitals in Turkey and the Impact of Co-morbid Malnutrition
Ethem Murat ARSAVA1, Tahsin Gokcem OZCAGLI2, Mehmet BERKTAS3, Semih GİRAY4, Ayse GULER5, Levent GUNGOR6, Ozcan OZDEMİR7, Kayihan ULUC8, Erdem YAKA9, Nilufer YESİLOT10, Mehmet Akif TOPCUOGLU1, Oznur SEYHUN2
1Department of Neurology, Hacettepe University Faculty of Medicine, Ankara, Turkey
2Abbott Nutrition Turkey, Istanbul, Turkey
3Yeditepe University Pharmacoeconomics and Pharmacoepidemiology Research Center (PEPIRC), Istanbul, Turkey
4Department of Neurology, Baskent University Faculty of Medicine, Ankara, Turkey
5Department of Neurology, Ege University Faculty of Medicine, Izmir, Turkey
6Department of Neurology, Ondokuz Mayis University Faculty of Medicine, Samsun, Turkey
7Department of Neurology, Osmangazi University Faculty of Medicine, Eskisehir, Turkey
8Department of Neurology, Marmara University Faculty of Medicine, Istanbul, Turkey
9Department of Neurology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
10Department of Neurology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
Objective: To evaluate the management and cost analysis of first-ever stroke patients in Turkey and determine the impact of comorbid malnutrition.

Methods: This study was based on expert's view on the management and cost analysis of stroke patients with or without malnutrition via standardized questionnaire forms filled by experts according to their daily clinical practice. Cost items were related to medical treatment, healthcare resources utilization, tests, consultations and complications. Per admission and total annual direct medical costs were calculated with respect to co-morbid malnutrition.

Results: Malnutrition was evident in 7.8(3.6)% [mean(standard error of mean; SEM)] of patients at admission; an additional 7.1(4.8)% and 0.9(0.6)% patients developed malnutrition during Neuro-ICU and stroke unit hospitalization, respectively. Length of hospital stay (LOS) was almost 2-fold in patients with malnutrition (P<0.01 for all hospital units). During the 1-year follow-up period a mean(SEM) of 93.8(15.4)% with and 43.3(3.7)% without malnutrition were expected to experience at least 1 complication. The mean (SEM) per patient annual cost of stroke was US$ 5201(740) in patients with malnutrition and US$ 3619(614) in patients without malnutrition, while the corresponding figures for per admission were US$ 3061(513) and US$ 1958(372), respectively.

Conclusions: In conclusion, our findings revealed that management of stroke and its complications have a relatively high burden on the Turkish health reimbursement system. Furthermore, co-morbid malnutrition, being not uncommonly encountered, increased the overall costs and was associated with longer LOS and higher rate of expected complications during 1-year follow up. Keywords : Stroke; malnutrition; cost analysis; direct medical cost; diagnosis; treatment; follow up; Turkey; expert panel