Vascular Health and Risk Management Open Access Full Text Article Dovepress open access to scientific and medical research O R i g i N A L R E s E A R c H costs and outcomes of noncardioembolic ischemic stroke in a managed care population Nicole M Engel-Nitz1 stephen D sander 2 carolyn Harley 3 gabriel gomez Rey 1 Hemal shah 2 1Health Economic and Outcomes Research, i3 innovus, Eden Prairie, MN, UsA; 2Health Economic and Outcomes Research, Boehringer ingelheim Pharmaceuticals, inc., Ridgefield, cT, UsA; 3Health Economic and Outcomes Research, i3 innovus, Palo Alto, c A, UsA correspondence: Nicole M Engel-Nitz i3 innovus, Health Economic and Outcomes Research, An ingenix company, 12125 Technology Drive, Eden Prairie, MN 55344, UsA Tel +1 952 833 8048 Fax +1 952 833 6045 Email nicole.engel-nitz@i3innovus.com submit your manuscript | www.dovepress.com Dovepress DOI: 10.2147/VHRM.S10851 Purpose: To evaluate the clinical outcomes and incremental health care costs of ischemic stroke in a US managed care population. Patients and methods: A retrospective cohort analysis was done on patients (aged 18+ years) hospitalized with noncardioembolic ischemic stroke from January 1, 2002, through December 31, 2003, identified from commercial health plan administrative claims. New or recurrent stroke was based on history in the previous 12 months, with index date defined as first date ofindication of stroke. A control group without stroke or transient ischemic attack (TIA) was matched (1:3) on age, sex, and geographic region, with an index date defined as the first medical claim during the patient identification period. Patients with atrial fibrillation or mitral value abnormalities were excluded. Ischemic stroke and control cohorts were compared on 4-year clinical outcomes and 1-year costs. Results: Of 2180 ischemic stroke patients, 1808 (82.9%) had new stroke and 372 (17.1%) had a recurrent stroke. Stroke patients had higher unadjusted rates of additional stroke, TIA, and fatal outcomes compared with the 6540 matched controls. Recurrent stroke patients had higher rates of adverse clinical outcomes compared with new stroke patients; costs attributed to recurrent stroke were also higher. Stroke patients were 2.4 times more likely to be hospitalized in follow-up compared with controls (hazard ratio [HR] 2.4, 95% confidence interval [CI]: 2.2, 2.6). Occurrence of stroke following discharge was 21 times more likely among patients with index stroke compared with controls (HR 21.0, 95% CI: 16.1, 27.3). Stroke was also predictive of death (HR 1.8, 95% CI: 1.3, 2.5). Controlling for covariates, stroke patients had significantly higher costs compared with control patients in the year following the index event. Conclusion: Noncardioembolic ischemic stroke patients had significantly poorer outcomes and higher costs compared with controls. Recurrent stroke appears to contribute substantially to these higher rates of adverse outcomes and costs. Keywords: burden of illness, stroke/cerebrovascular accident, cardiovascular disease, claims analysis, costs of care, health care outcomes Background Stroke is a major cause of serious, long-term disability, mortality, and institutionalization, and it accounts for substantial use of health care resources.1–4 When considered separately from other cardiovascular diseases, stroke ranks third among all causes of death, following diseases of the heart and cancer.5 Among survivors, ∼15%–30% are permanently disabled and 20% require institutional care 3 months after onset.6 As a result, stroke imposes a significant economic impact, with stroke-related costs making up as much as 3%–4% of the annual national health care budget.1,2 For 2009, the estimated direct and indirect cost of stroke in the United States was $68.9 billion.6 Vascular Health and Risk Management 2010:6 905–913 905 © 2010 Engel-Nitz et al, publisher and licensee Dove Medical Press Ltd.This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.