Mechanical thrombectomy was found to cost three times more than medical therapy, driven by longer hospital stays.
MRI of head of elderly woman in hands of doctor standing in medical ward near senior patient with relative and nurse.
Study: Cost evaluation of acute ischemic stroke in Latin America: a multicentric study. Image Credit: Peakstock/Shutterstock.com
In a recent study published in The Lancet Regional Health – Americas, a team of South American researchers evaluated the direct costs of acute ischemic stroke care in Latin America using Time-Driven Activity-Based Costing (TDABC). They analyzed patient data from eight countries to identify cost drivers, treatment variations, and economic disparities. The researchers aimed to use the findings to support health policy improvements and foster the adoption of value-based healthcare strategies in the region.
Background
Stroke is one of the major causes of disability and mortality globally, with its impact being particularly severe in low- and middle-income countries due to limited access to advanced healthcare services. Projections also suggest a significant rise in stroke-related mortality and economic burden, with annual costs expected to exceed $2 trillion by 2050.
Furthermore, while evidence from many studies supports the cost-effectiveness of treatments such as mechanical thrombectomy (MT) and intravenous thrombolysis (IVT) their accessibility remains a challenge in resource-limited settings. Disparities in healthcare infrastructure, funding, and public awareness further hinder the optimal management of stroke in low- and middle-income countries.
Moreover, the lack of standardized methodologies to evaluate stroke costs also complicates the formulation of efficient care strategies. Studies have found that TDABC is a robust tool for assessing resource allocation and guiding value-based healthcare. It could potentially be used to assess stroke cost data and provide results to inform policies that enhance treatment accessibility and sustainability.
About the study
In this multicenter study, the researchers employed a cross-sectional design to analyze the direct costs of acute ischemic stroke treatment across eight Latin American countries. Data were collected between December 2021 and December 2022 at certified stroke centers, ensuring uniformity in care protocols. The study also adopted a hospital-centric perspective, focusing on public and private institutions, with costs assessed through the TDABC methodology.
The patient data encompassed 1106 cases of acute ischemic stroke, with costs stratified by treatment type, which included medical management, IVT, MT, and combined IVT plus MT, as well as information on clinical risk levels. The study utilized validated stroke scores, including the National Institute of Health Stroke Scale (NIHSS) at admission and the modified Rankin Scale (mRS) at discharge and three months.
Institutional costs were calculated through detailed mapping of patient care pathways, covering the five main phases from emergency to stroke unit, covering general ward, angiography, and intensive care unit. Additionally, resource utilization was evaluated in terms of professional time, diagnostic procedures, medications, and infrastructure.
The researchers also incorporated purchasing power parity adjustments and converted the costs to International Dollars (I$) to facilitate comparisons with findings from other countries. In addition, statistical analyses, including generalized estimating equation models, were used to examine the relationship between clinical variables and total patient costs.
Results
The findings reported that acute ischemic stroke treatment costs in Latin America varied widely and were influenced by clinical risk levels, treatment types, and hospital resource utilization. The average cost per patient was I$ 12,203, with significant disparities across countries and treatment modalities. While patients receiving medical management incurred the lowest mean costs, those undergoing MT or combined IVT and MT faced the highest expenses.
Related Stories
The duration of hospital stay was identified as the primary cost driver, impacting medication use, diagnostic procedures, and infrastructure utilization. High-risk patients had substantially higher costs compared to medium—or low-risk groups, with a mean expense of I$17,438 for high-risk individuals.
Treatment costs were also found to escalate with increasing stroke severity, as indicated by the NIHSS and mRS scores. For example, patients with severe disability, having a mRS score of 5, incurred mean costs exceeding I$ 22,000, which was reflective of the intensive care requirements.
Moreover, country-specific analyses revealed notable cost variations. Brazil had the highest costs for most treatments, attributed to longer hospital stays and higher structural expenses. Conversely, Peru reported the lowest mean costs. The study also identified significant disparities in treatment access, with some centers unable to provide advanced interventions such as MT.
However, despite the higher costs, advanced treatments such as MT and combined IVT plus MT were associated with better clinical outcomes, emphasizing the importance of improving access to these interventions.
Conclusions
In summary, the results reported significant economic and accessibility disparities in stroke treatment across Latin America and emphasized the importance of addressing these challenges through targeted health policies.
The researchers inferred that healthcare systems can enhance stroke care outcomes while reducing the economic burden by adopting standardized costing methods and improving access to advanced treatments. These insights could serve as a foundation for policy initiatives aimed at equitable, sustainable, and effective healthcare delivery in resource-constrained settings.
Journal reference:
Dittrich, L. B., Etges, S., Joana, Allein, M., Rocha, E., Amaya, P., Barboza, M. A., Saavedra, A. G., Hornos, G. P., Abanto, C., Castillo-Soto, A. L., Llanos-Leyton, N., Lereis, V. P., Soledad, Alet, M., Navia, V., Lopez, S., Arauz, A., Serrano, F., & Chwal, B. (2025). Cost evaluation of acute ischemic stroke in Latin America: a multicentric study. The Lancet Regional Health – Americas, 41. DOI:10.1016/j.lana.2024.100959
https://www.thelancet.com/journals/lanam/article/PIIS2667-193X(24)00286-2/fulltext