The Canadian Press
Date: Tuesday Jun. 8, 2010 10:05 AM ET
The national study tallied the financial cost of a stroke in the first six months -- to both the health-care system and the patient -- and found the expense adds up to an average of $50,000 per person, with about 20 per cent of that hitting families in the pocketbook.
When the $50,000 total is multiplied by more than 50,000 new strokes per year in the Canadian population, it works out to a whopping $2.5 billion or more a year, according to the Burden of Ischemic Stroke study being presented Tuesday at the Canadian Stroke Congress in Quebec City.
"We wanted to know how much stroke costs the health-care system and patients and their families, and there had never been a national study done on this prior to this," said Dr. Mike Sharma, deputy director of the Canadian Stroke Network.
"We looked at 12 different hospitals spread across the country from Halifax to Vancouver, and we took patients who'd had stroke, after they were leaving the hospital, and gave them a diary and arranged to meet with them periodically afterwards."
Sharma, who's with the University of Ottawa and Ottawa Hospital, led the study with Dr. Nicole Mittmann of Sunnybrook Health Science Centre in Toronto. They looked at the health-care costs of 232 patients.
In their diaries, patients or a caregiver tracked appointments, medications, whether they'd had to buy canes or wheelchairs, or modify homes with ramps or other features to make them safe and accessible. They also factored in how much time a caregiver had to spend away from a job.
Sharma said the grand total came as a surprise to him.
"The average cost over the first six months was $50,000 -- and this is probably about double what I would have estimated prior to this data being available," he said.
The personal tallies ranged from a low of about $2,000 for those who essentially had no disability to more than $200,000 for individuals who were quite disabled, he said.
The average length of stay in hospital after a stroke varies widely. Sharma said Ontario has worked hard to reduce the time, and it's now less than 10 days on average in the province, but "considerably more" in other jurisdictions.
In terms of a breakdown, he was also surprised to find that 80 per cent of the total cost was related to the health-care system, in particular hospitalization, while the other 20 per cent related to lost time from jobs and expenses for families.
"The times where it makes life very difficult are in those individuals who aren't covered with health-care plans, and when the primary breadwinner in the family has been affected by stroke. So there you've got the worst of both worlds. The income for that family declines while their costs go up."
After someone has a stroke, Sharma said medications are needed to prevent more stroke and for depression and sleep issues that arise.
Frank Nieboer of Calgary can speak from experience about the difficulties families face when someone has a stroke. His wife Lou had an aneurysm -- bleeding in the brain -- 33 years ago at the age of 32.
After seven weeks in hospital, she was deemed stable enough to come home, but she was in a wheelchair and had lost the use of her right arm, right leg, her ability to speak, and she was "massively depressed" and crying all the time, he said.
"And here I am, I'm 33, I've got a day job, thank you very much, and what are we doing?" he said. "It's really a learning curve."
Lou's income was wiped out because she had to resign her bank job. Fortunately, Nieboer was in a good financial position and able to get private help for physiotherapy, occupational therapy and assistance working on speech and cognitive processes.
The Nieboers formed a support group in Calgary and have helped counsel many families, hearing in the process numerous stories about the crippling financial burden of stroke.
"A lot of younger families, it results in family breakup," Nieboer said. Sometimes a breadwinner leaves a partner and young children after the partner's had a stroke, and the family must turn to social supports, he said.
Other times, a breadwinner -- for instance a trucker, teacher or lawyer -- can't work because of physical effects, or the impact on the ability to speak. Cognitive processes can also be affected.
"You may present very well from the outside, but a lot of folks have what I call invisible deficits. They can't process information. They can't quickly process and respond," Nieboer said.
Sharma said 50,000 to 60,000 strokes a year are diagnosed, but 10 times that number are covert. It's known they occurred because scars are seen on imaging, but they weren't diagnosed because there were none of the classical symptoms. They are, however, associated with dementia and long-term difficulties.
About 87 per cent of diagnosed strokes are due to blocked blood vessels, while 13 per cent are due to bleeding, Sharma said. There are effective treatments for the blockages, such as the clot-busting medication tPA.
"If we can get at it very quickly in a centre that has expertise and if we give that treatment, we know that the probability of disability is decreased by a third," he said.
"And that is what you need to do to shift that burden from somebody who is significantly disabled to somebody who has absolutely no disability, and consequently shift the cost from those very large numbers down to one-hundredth of them."
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