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The hospital costs of care for stroke in nine European countries

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Author Info

  • David Epstein

    (Centre for Health Economics, University of York, UK)

  • Anne Mason

    (Centre for Health Economics, University of York, UK)

  • Andrea Manca

    (Centre for Health Economics, University of York, UK)

Abstract

Stroke is a major cause of mortality and morbidity, but the reasons for differences in costs of care within and between countries are not well understood. The HealthBASKET project used a vignette methodology to compare the mean costs and prices of hospital care across providers in nine European Union countries. Data on resource use, unit costs and prices of care for female stroke patients without co-morbidity were collected from a sample of 50 hospitals. Mean costs for each provider were analysed using multiple regression. Sensitivity analysis explored the effects on cost of using official exchange rates, purchasing power parity (PPP) and proportion of national income per capita. The mean cost of a hospital episode per patient for stroke at PPP was €3813 (standard error 227) with an additional day in hospital typically associated with 6.9% (95% CI: 4-9%) higher costs and thrombolysis associated with 41% higher costs (10-73%). After adjusting for explanatory factors, about 76% of the variation in cost could be attributed to between-country differences, and the extent of this variation was sensitive to the method of currency conversion. There was considerable variation in the care pathways within and between countries, including differences in the availability of stroke units and access to rehabilitative services, but only the length of stay and use of thrombolytic therapy were significantly associated with higher cost. The vignette methodology appears feasible, but further research needs to consider access to healthcare over a longer follow up and to include both costs and outcomes. Copyright © 2008 John Wiley & Sons, Ltd.

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File URL: http://hdl.handle.net/10.1002/hec.1329
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Bibliographic Info

Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

Volume (Year): 17 (2008)
Issue (Month): S1 ()
Pages: S21-S31

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Handle: RePEc:wly:hlthec:v:17:y:2008:i:s1:p:s21-s31

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Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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  1. Unto Häkkinen & Isabelle Joumard, 2007. "Cross-Country Analysis of Efficiency in OECD Health Care Sectors: Options for Research," OECD Economics Department Working Papers 554, OECD Publishing.
  2. J. A. Hausman, 1976. "Specification Tests in Econometrics," Working papers 185, Massachusetts Institute of Technology (MIT), Department of Economics.
  3. Jonas Schreyögg & Oliver Tiemann & Tom Stargardt & Reinhard Busse, 2008. "Cross-country comparisons of costs: the use of episode-specific transitive purchasing power parities with standardised cost categories," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages S95-S103.
  4. Manning, Willard G., 1998. "The logged dependent variable, heteroscedasticity, and the retransformation problem," Journal of Health Economics, Elsevier, vol. 17(3), pages 283-295, June.
  5. Richard Grieve & Richard Nixon & Simon G. Thompson & Charles Normand, 2005. "Using multilevel models for assessing the variability of multinational resource use and cost data," Health Economics, John Wiley & Sons, Ltd., vol. 14(2), pages 185-196.
  6. Breusch, T S & Pagan, A R, 1979. "A Simple Test for Heteroscedasticity and Random Coefficient Variation," Econometrica, Econometric Society, vol. 47(5), pages 1287-94, September.
  7. Sarah Wordsworth & Anne Ludbrook, 2005. "Comparing costing results in across country economic evaluations: the use of technology specific purchasing power parities," Health Economics, John Wiley & Sons, Ltd., vol. 14(1), pages 93-99.
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Cited by:
  1. Raymond Oppong & Joanna Coast & Kerry Hood & Jacqui Nuttall & Richard Smith & Christopher Butler, 2011. "Resource use and costs of treating acute cough/lower respiratory tract infections in 13 European countries: results and challenges," The European Journal of Health Economics, Springer, vol. 12(4), pages 319-329, August.
  2. Jonas Schreyögg & Oliver Tiemann & Tom Stargardt & Reinhard Busse, 2008. "Cross-country comparisons of costs: the use of episode-specific transitive purchasing power parities with standardised cost categories," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages S95-S103.
  3. Reinhard Busse & Jonas Schreyögg & Peter C. Smith, 2008. "Variability in healthcare treatment costs amongst nine EU countries - results from the Health BASKET project," Health Economics, John Wiley & Sons, Ltd., vol. 17(S1), pages S1-S8.
  4. M. Pirson & L. Schenker & D. Martins & Duong Dung & J. Chalé & P. Leclercq, 2013. "What can we learn from international comparisons of costs by DRG?," The European Journal of Health Economics, Springer, vol. 14(1), pages 67-73, February.

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