Supplementary Material for: Current and Future Cost Burden of Ischemic Stroke in Australia: Dynamic Model

Background: Stroke remains one of the leading causes of morbidity and mortality in Australia. The objective of this study was to estimate the current and future cost burden of ischemic stroke (IS) in Australia.

Method: First, chronic management costs following IS were derived for all people aged ≥ 30 years discharged from a public or private hospital in Victoria, Australia between July 2012 and June 2017 (n = 34 471). These costs were then used to project total costs following IS (combination of acute event and chronic management cost) over a 20-year period (2019-2038) for people aged between 30 and 99 years in Australia using a dynamic multistate lifetable model. Data for the dynamic model were sourced from the Victorian Admitted Episodes Dataset (VAED) and supplemented with other published data.

Result: The estimated annual total chronic management cost following IS was 13 525 Australian dollars (AUD) per person (95%CI: AUD 13 380, AUD 13 670) for cohorts in the VAED between July 2012 and June 2017. The annual chronic management cost was estimated to decline following IS. The highest cost was incurred in the first year of follow-up post-IS (AUD 14 309 per person) and declined to AUD 9 776 in the sixth year of follow-up post-IS. The total healthcare cost for people aged 30-99 years was projected to be AUD 47.7 billion (95% UI: AUD 44.6 billion, AUD 51.0 billion) over the 20-year period (2019-2038) Australia-wide, of which 91.3% (AUD 43.6 billion) was attributed to chronic management costs and the remaining 8.7% (AUD 4.2 billion) were due to acute IS events.

Conclusion: IS has and will continue to have a considerable financial impact in the next two decades on the Australian healthcare system. Our estimated and projected cost burden following IS provides important information for decision making in relation to IS.

背景：脑卒中仍是澳大利亚发病率与死亡率居高不下的主要病因之一。本研究旨在评估澳大利亚缺血性脑卒中（ischemic stroke, IS）当前及未来的成本负担。
方法：首先，本研究针对2012年7月至2017年6月期间，从澳大利亚维多利亚州公立及私立医院出院的所有30岁及以上缺血性脑卒中患者（n=34471），推导其脑卒中后的慢性管理成本。随后，研究采用动态多状态寿命表模型（dynamic multistate lifetable model），针对澳大利亚30至99岁人群，对2019至2038年这20年间的缺血性脑卒中后总费用（含急性发作与慢性管理成本）进行测算。本动态模型的数据来源于维多利亚州入院病例数据集（Victorian Admitted Episodes Dataset, VAED），并辅以其他已发表研究数据。
结果：2012年7月至2017年6月期间，维多利亚州入院病例数据集队列的缺血性脑卒中患者年慢性管理总成本估算为每人13525澳元（AUD），95%置信区间（95%CI）为13380~13670澳元。研究估算显示，缺血性脑卒中后的年慢性管理成本呈下降趋势：随访首年的成本最高，达每人14309澳元，至随访第6年时降至9776澳元。预计2019至2038年的20年间，澳大利亚全国30至99岁人群的缺血性脑卒中相关医疗总费用将达477亿澳元，95%不确定性区间（95% UI）为446亿~510亿澳元；其中91.3%（436亿澳元）源于慢性管理成本，剩余8.7%（42亿澳元）来自急性缺血性脑卒中发作的相关费用。
结论：缺血性脑卒中当前已对澳大利亚医疗系统造成显著经济负担，且未来二十年这一态势仍将持续。本研究估算并预测的缺血性脑卒中后成本负担，可为缺血性脑卒中相关决策提供重要参考依据。