Ischemic Stroke Has .2 Trillion Total Price Tag Through 2050

ANN ARBOR, Mich., Aug. 16 -- When the cumulative bill for ischemic stroke comes due in 2050 it is likely to total .2 trillion, and that's a conservative estimate, calculated researchers here.

The total cost of ischemic stroke from 2005 to 2050, in 2005 dollars, is projected to be .52 trillion for non-Hispanic whites, billion for Hispanics, and billion for African Americans, added up Devin Brown, M.D., M.S., of the University of Michigan, and colleagues.

The high cost of stroke care is an example of a perfect demographic storm-an aging population, combined with an increase in ethnic groups at risk for stroke, and an health care system that emphasizes acute rather than preventive care.

"Doing the right thing now ultimately could be cost-saving in the future, but we have a long way to go before all Americans receive adequate stroke prevention and emergency stroke care," Dr. Brown and colleagues said today online in Neurology, where their projections were published.

If, however, society is not motivated to improve stroke prevention by the public health message, she said "perhaps we can do it because it's going to be obscenely expensive."

Neurology, which is the journal of the American Academy of Neurology, had originally scheduled the stroke cost paper for publication Oct. 24, but decided to push it ahead as an e-publication "due to the nature of this news."

The AAN is using the study by Dr. Brown and colleagues to press the academy's case for more federal funding for stroke research.

Catherine M. Rydell, CEO and executive director of the academy, said her group wants an increase of 5% (.4 billion) from Congress, which would bring stroke research funding to billion in fiscal year 2007. But the main issue right now is that the House of Representatives is proposing a stroke-funding package that is million less than a Senate proposal.

The authors based their estimates on an analysis of data from two ongoing stroke studies-the Northern Manhattan Stroke Study and the Brain Attack Surveillance in Corpus Christi, Tex. Both studies have large Hispanic populations, which strengthens the studies' projections for stroke in this population, but both have relatively small African American populations, which could have minimized the accuracy of predictions for that group.

In 2005 there were 70 million Americans ages 45 to 64 living in the United States as well as 30 million ages 65 to 84 and five million ages 85 and older. Looking ahead to 2050 those numbers jump to 78 million, 56 million and 17 million, respectively.

Likewise, in 2005 non-Hispanic whites comprised an estimated 70% of the population, Hispanics 13%, and African-Americans 12%, but in 2050 that numbers will shift so that 53% will be non-Hispanic whites, 25% Hispanic, and 14% African American.

That shift is important because the weighted average annual incidence of stroke is 11 per 10,000 for whites younger than 64 and 60 per 10,000 for those 65 to 84, versus 23 per 10,000 for Hispanics ages 45 to 64, and 87 per 10,000 for Hispanics ages 65 to 84. Among those 85 or older the rate was 180 per 10,000 for both whites and Hispanics.

African-Americans have the highest ischemic stroke risk for those younger than 65, 33 per 10,000, but the risk for African Americans 65 to 84 is the same as Hispanics. African Americans who reach age 85 have a slightly lower stroke incidence than either whites or Hispanics, 170 per 10,000 population.

Stroke prevalence is lowest for whites, 2% for those age 45 to 64 versus 2.3% in Hispanics and 4.8% in African Americans. After age 65 the prevalence rates are 9% for whites and 10% for Hispanics and African Americans.

Per capita stroke costs are also highest for African Americans, ,782, followed by Hispanics, ,201 and non-Hispanic whites ,597.

"Lost earning and informal care giving were the highest two individual cost contributors in all race-ethnic groups, constituting approximately half of the total costs in each group," the authors wrote.

Lost wages and care giving costs were followed by costs of initial hospitalization and costs of drugs.

The authors wrote that there is an urgent need to for cost-saving treatments such as Coumadin (warfarin) treatment for primary prophylaxis of atrial fibrillation and use of thrombolytic drugs such as Alteplase (recombinant tissue plasminogen activator) for ischemic stroke, as well as cost-effective treatments such as carotid endarterectomy.

Smoking cessation and improved hypertension management are also key elements of stroke prevention, they wrote.

"Inequalities in health care for minorities and barriers to receiving quality care need to be recognized and addressed so that all minorities can receive the full benefit of these stroke-prevention therapies," they wrote.

The authors said the study is limited by its reliance on Medicare reimbursement as a proxy for societal costs, but Medicare payments are dynamic so changes in reimbursement policy could affect costs.