Dobe et al database

<b>Background: </b>Stroke is an often-deadly condition responsible for a substantive burden on survivors and their family. Addressing a paucity of African-specific data, we investigated the cost of stroke management and the recovery of health-related quality of during and post-hospitalization in Mozambique.<b>Methods</b>: A prospective, cost-of-illness study examining the direct and indirect costs of acute stroke presentations to a first referral urban public hospital in Maputo, Mozambique (June-December 2019). Direct costs were derived from medical records to estimate the cost of hospital care. Indirect costs were derived from structured interviews with patients or their caregiver during the index hospitalization and 28-days post-discharge to estimate additional expenditure and loss of productivity due to disability which varied by employment status (informal, formal, pensioner and unemployed). Health-related quality-of-life was assessed at 28-days post stroke using the EQ-5D-3L questionnaire. Cost analysis was conducted from a societal perspective and reported in $USD.Results: 50 of 80 patients admitted with an acute stroke were consecutively recruited during the study period. Median age was 61 (IQR 38 to 68) years, 56% were women and 44% presented with a hemorrhagic stroke. Median length of stay in hospital stay was 7.0 (IQR 4.0 to 8.0) days. Within 28-days post-discharge 20% patients had died. The estimated total direct cost of hospital care for 50 patients was $35.303, the median cost per patient was $721.45 (IQR 582; 790). The estimated direct non-medical costs per patient during hospitalization median $12,59 (IQR, 8.19; 16.39) and mean $13.62 (SD 8.02). In the first 28 days after discharge the non-medical cost was: $32.04 (IQR, 19,01; 49.83) and mean $41.37. Overall, loss of productivity was very high in the informal employment and quality of life in survivors severely compromised. The mean EQ-5D index and VAS scores of stroke patients were 0.514 (SD, 0.298), and 49.39 (SD, 20.95), respectively. Anxiety/depression 92.5% and Pain/discomfort 82.5% were the most frequently reported issues. <b>Conclusion: </b>The economic cost of stroke in low-income sub-Saharan African countries such as Mozambique is substantially high, with considerable out-of-pocket spending, poor survival rate and a compromised health-related quality-of-life. Health system reforms designed to mitigate the individual to societal burden imposed by stroke are required.