Background: The recently-observed trend towards younger stroke patients in Korea raises economic concerns, including erosion of the workforce. We compared per-person lifetime costs of stroke according to the age of stroke onset from the Korean societal perspective. Methods. A state-transition Markov model consisted of three health states ('post primary stroke event', 'alive post stroke', and 'dead') was developed to simulate the natural history of stroke. The transition probabilities for fatal and non-fatal recurrent stroke by age and gender and for non-stroke causes of death were derived from the national epidemiologic data of the Korean Health Insurance Review and Assessment Services and data from the Danish Monitoring Trends in Cardiovascular Disease study. We used an incidence-based approach to estimate the long-term costs of stroke. The model captured stroke-related costs including costs within the health sector, patients' out-of-pocket costs outside the health sector, and costs resulting from loss of productivity due to morbidity and premature death using a human capital approach. Average insurance-covered costs occurring within the health sector were estimated from the National Health Insurance claims database. Other costs were estimated based on the national epidemiologic data and literature. All costs are presented in 2008 Korean currency values (Korean won = KRW). Results: The lifetime costs of stroke were estimated to be: 200.7, 81.9, and 16.4 million Korean won (1,200 KRW is approximately equal to one US dollar) for men who suffered a first stroke at age 45, 55 and 65 years, respectively, and 75.7, 39.2, and 19.3 million KRW for women at the same age. While stroke occurring among Koreans aged 45 to 64 years accounted for only 30% of the total disease incidence, this age group incurred 75% of the total national lifetime costs of stroke. Conclusions: A higher lifetime burden and increasing incidence of stroke among younger Koreans highlight the need for more effective strategies for the prevention and management of stroke especially for people between 40 and 60 years of ages.
Bibliographical noteFunding Information:
The present study was funded by the Korea Ministry of Health, Welfare, and Family Affairs in 2006.
The costs within the health sector consisted of insurance-covered and insurance-noncovered medical costs, informal caregiver costs, and transportation costs to visit health care institutions. Records from the Korean National Health Insurance (NHI) claims database from 2001 to 2004 were used to identify patients with stroke and resource use for insurance-covered medical services associated with stroke. Since the present study was funded by the Korea Ministry of Health, Welfare, and Family Affairs, we were able to obtain the NHI claims data through a formal request process submitted to the Korean National Health Insurance Corporation. Since Korea has a mandatory system for national health insurance, the NHI claims database contains all medical and prescription drug claims records for the entire population. All patients aged 45 or older with at least one claim record of outpatient visits or hospital admissions, containing a primary or secondary diagnosis of stroke (ICD 10 code: I60-64) in 2002 were identified from the NHI claims database. The one-year period prior to 2002 was set to be a ‘window period,’ such that patients were defined as incident cases only if they didn’t have any record of a stroke-related claim during the window period. We defined the case of non-fatal stroke as cases without death within one year after the stroke onset. If patients died within one year after the stroke onset, these cases were defined as fatal stroke. The NHI claims database contained de-identified identification number and we were not able to determine the individual’s identity. None of protected health information was included in the received data. All data were stored in a password protected personal computer.
All Science Journal Classification (ASJC) codes
- Public Health, Environmental and Occupational Health