Modified Rankin scale as a determinant of direct medical costs after stroke

Background: Resource use in the acute and subacute phases after stroke depends on the degree of disability. Aims: To determine if direct costs after stroke also vary by level of disability as measured using the modified Rankin scale at the chronic stage after stroke. Methods: In a multicentre study, we collected acute and chronic in- and outpatient resource use in survivors of ischemic stroke stratified by levels of disability according to the modified Rankin Scale. Statistical inference on costs at each level of the modified Rankin Scale was estimated using a general linear model for the first three months, the first year, and any subsequent year after ischemic stroke. Results: A total of 569 survivors of ischemic stroke with a mean age of 71.7 years were enrolled (41% female) from 10 academic and nonacademic centers. Costs varied substantially over time and with each modified Rankin Scale level. The total average costs in the first year were estimated $33,147 per patient, ranging from $9,114 for modified Rankin Scale 0 to $83,236 for modified Rankin Scale 5. In the second year, medical costs were on average $14,039, varying from $2,921 to $39,723 for patients with modified Rankin Scale 0–5. The level of disability based on the modified Rankin Scale was a major determinant of resource use, irrespective of age, gender, atrial fibrillation, and vascular risk factors. Conclusion: Long-term resource use after stroke is high and is mainly driven by degree of disability as measured by the modified Rankin scale.