ESO East Supplement 2023 - 21

1123840
research-article2022
ESO0010.1177/23969873221123840European Stroke JournalBenković et al.
ESO EAST Project Supplement
The cost of ischaemic stroke in Croatia
Vanesa Benković1, Mark Parker2, Tanja Novaković2,
Andrija Meštrović3 and Hrvoje Budinčević3,4
Abstract
Objective: The aim of this analysis was to estimate 1 year and long-term cost and quality of life of ischaemic stroke
patients in Croatia. In addition, we aimed to identify and estimate key categories of costs and outcomes driving the
burden of stroke in Croatian healthcare system.
Methods: Data were derived from analysis of the RES-Q Registry for Croatia in 2018 and supplemented with clinical
expert opinion and relevant medical, clinical and economic literature to estimate the course of the disease and treatment
patterns in Croatian healthcare system. The health economic model was comprised of a one-year discrete event
simulation (DES) mapping real life patient experience and a 10-year Markov model built on existing literature. Cost and
health resources use were obtained using Croatian tariffs. Health utilities were mapped to EQ5D from the Barthel Index
utilising previously published studies.
Results: The key aspects determining costs and quality of life were rehabilitation, discharge to residential care (currently
13% of patients in Croatia) and recurrent stroke. Total 1 year cost per patient was 18,221 EUR having 0.372 QALYs.
Conclusion: Direct costing structure of ischaemic stroke in Croatia is above the value of upper-middle income
countries. Our study showed that post stroke rehabilitation seems to be a strong modifier of future post-stroke costs
and further research into various models of post-stroke care and rehabilitation could be the answer into more successful
rehabilitation that could increase QALY and reduce the economic burden of stroke. Further investment in rehabilitation
research and provision might bring promising opportunities to improve long term patient outcomes.
Keywords
Stroke, ischaemic stroke, stroke costs
Date received: 28 July 2022; accepted: 16 August 2022
European Stroke Journal
2023, Vol. 8(1S) 21 -27
© European Stroke Organisation 2022
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DOI: 10.1177/23969873221123840
journals.sagepub.com/home/eso
https://doi.org/10.1177/23969873221123840
Introduction
Stroke is the leading cause of disability worldwide.1,2
Despite the reduction in mortality rates over the last two
decades, stroke related burden has been rising, especially in
developing countries. Stroke is the second largest contributor
after ischaemic heart disease globally and in developing
countries and the third largest contributor to disabilityadjusted
life-years
(DALY) in developed
countries.3
Changes in healthcare provision, risk awareness, data collection
and analysis over the recent decade has revolutionised
healthcare decision making and understanding towards
the best outcomes for stroke patients.4
These changes represent a good response to increasing incidence
as between 1990 and 1999 stroke incidence in Croatia
increased almost two-fold and has been one of the leading mortality
causes.5,6 Croatia has a public health care system with a
single universal coverage insurer, Croatian Health Insurance
Fund, based on Beveridge-Bismarck financing for taxes and
contributions.7 All of the costs (acute care and rehabilitation)
are reimbursed by National Health Insurance Fund, which is
using Diagnostic-Related Group (DRG) system.7
As in many European countries, Croatia measure quality
of stroke care through the Registry for Stroke Care Quality
(RES-Q) - a registry tool for evaluating stroke care quality
1 Croatian Society for Pharmacoeconomics and Health Economics,
Zagreb, Croatia
2 Zem Solutions Ltd., Belgrade, Serbia
3 Stroke and Intensive Care Unit, Department of Neurology, Sveti Duh
University Hospital, Zagreb, Croatia
4 Faculty of Medicine, Department of Neurology and Neurosurgery, J.J.
Strossmayer University of Osijek, Osijek, Croatia
Corresponding author:
Hrvoje Budinčević, Stroke and Intensive Care Unit, Department of
Neurology, Sveti Duh University Hospital, Sveti Duh 64, Zagreb, 10000,
Croatia.
Email: hbudincevic@gmail.com
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