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The One-Year Attributable Cost of Post-stroke Dysphagia

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Abstract

With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies.

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References

  1. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127:e6–245.

    Article  PubMed  Google Scholar 

  2. Taylor TN, Davis PH, Torner JC, Holmes J, Meyer JW, Jacobson MF. Lifetime cost of stroke in the United States. Stroke. 1996;27:1459–66.

    Article  PubMed  CAS  Google Scholar 

  3. Guyomard V, Fulcher RA, Redmayne O, Metcalf AK, Potter JF, Myint PK. Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study. J Am Geriatr Soc. 2009;57:2101–6.

    Article  PubMed  Google Scholar 

  4. Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke. 1999;30:744–8.

    Article  PubMed  CAS  Google Scholar 

  5. Heckert KD, Komaroff E, Adler U, Barrett AM. Postacute reevaluation may prevent dysphagia-associated morbidity. Stroke. 2009;40:1381–5.

    Article  PubMed  PubMed Central  Google Scholar 

  6. González-Fernández M, Gardyn M, Wyckoff S, Ky PK, Palmer JB. Validation of ICD-9 Code 787.2 for identification of individuals with dysphagia from administrative databases. Dysphagia. 2009;24:398–402.

    Article  PubMed  Google Scholar 

  7. Joynt KE, Jha AK. Thirty-day readmissions–truth and consequences. New Engl J Med. 2012;366:1366–9.

    Article  PubMed  CAS  Google Scholar 

  8. Prabhakaran S, McNulty M, O’Neil K, Ouyang B. Intravenous thrombolysis for stroke increases over time at primary stroke centers. Stroke. 2012;43:775–877.

    Google Scholar 

  9. Gresham GE, Alexander D, Bishop DS, Giuliani C, Goldberg G, Holland A, Kelly-Hayes M, Linn RT, Roth EJ, Stason WB, Trombly CA. American Heart Association Prevention Conference. IV. Prevention and rehabilitation of stroke. Rehabilitation. Stroke. 1997;28:1522–6.

    Article  PubMed  CAS  Google Scholar 

  10. Beavan J, Conroy SP, Harwood R, Gladman JR, Leonardi-Bee J, Sach T, Bowling T, Sunman W, Gaynor C. Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial. Age Ageing. 2010;39:624–30.

    Article  PubMed  Google Scholar 

  11. Kotecki S, Schmidt R. Cost and effectiveness analysis using nursing staff-prepared thickened liquids versus commercially thickened liquids in stroke patients with dysphagia. Nurs Econ. 2010;28:106–13.

    PubMed  Google Scholar 

  12. Crary MA, Carnaby-Mann GD, Groher ME, Helseth E. Functional benefits of dysphagia therapy using adjunctive sEMG biofeedback. Dysphagia. 2004;19:160–4.

    PubMed  Google Scholar 

  13. Wojner AW, Alexandrov AV. Predictors of tube feeding in acute stroke patients with dysphagia. AACN Clin Issues. 2000;11:531–40.

    Article  PubMed  CAS  Google Scholar 

  14. Odderson IR, Keaton JC, Mckenna BS. Swallow management in patients on an acute stroke pathway: quality is cost effective. Arch Phys Med Rehabil. 1995;76:1130–3.

    Article  PubMed  CAS  Google Scholar 

  15. Cichero JA, Heaton S, Bassett L. Triaging dysphagia: nurse screening for dysphagia in an acute hospital. J Clin Nurs. 2009;18:1649–59.

    Article  PubMed  Google Scholar 

  16. Wilson RD, Howe EC. A cost-effectiveness analysis of screening methods for dysphagia after stroke. PM R. 2011;4:273–82.

    Article  PubMed  Google Scholar 

  17. Wilson RD. Mortality and cost of pneumonia after stroke for different risk groups. J Stroke Cerebrovasc Dis. 2012;21:61–7.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Gonzalez-Fernandez M, Kuhlemeier KV, Palmer JB. Racial disparities in the development of dysphagia after stroke: analysis of the California (MIRCal) and New York (SPARCS) inpatient databases. Arch Phys Med Rehabil. 2008;89:1358–65.

    Article  PubMed  Google Scholar 

  19. Bussell SA, Gonzalez-Fernandez M. Racial disparities in the development of dysphagia after stroke: further evidence from the Medicare database. Arch Phys Med Rehabil. 2011;92:737–42.

    Article  PubMed  Google Scholar 

  20. Smithard DG, Smeeton NC, Wolfe CD. Long-term outcome after stroke: does dysphagia matter? Age Ageing. 2007;36:90–4.

    Article  PubMed  CAS  Google Scholar 

  21. Reker DM, Hamilton BB, Duncan PW, Yeh SJ, Rosen A. Stroke. Who’s counting what? J Rehabil Res Dev. 2001;38:281–9.

    PubMed  CAS  Google Scholar 

  22. Ellis C, Simpson AN, Bonilha HS, Mauldin PD, Simpson KN. One year cost of post-stroke aphasia. Stroke. 2012;43:1429–31.

    Article  PubMed  Google Scholar 

  23. Montez-Rath M, Christiansen CL, Ettner SL, Loveland S, Rosen AK. Performance of statistical models to predict mental health and substance abuse cost. BMC Med Res Methodol. 2006;6:53–63.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Manning WG, Basu A, Mullahy J. Generalized modeling approaches to risk adjustment of skewed outcomes data. J Health Econ. 2005;24:465–88.

    Article  PubMed  Google Scholar 

  25. Kutner MH, Nachtscheim CJ, Neter J, Li W. Applied linear statistical models. 5th ed. Chicago: McGraw Hill/Irwin; 2004.

    Google Scholar 

  26. Engel-Nitz NM, Sander SD, Harley C, Rey GG, Shah H. Costs and outcomes of noncardioembolic ischemic stroke in a managed care population. Vasc Health Risk Manag. 2010;6:905–13.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Spolaore P, Brocco S, Fedeli U, Visentin C, Schievano E, Avossa F, Milan G, Toso V, Vanuzzo D, Pilotto L, Pessina AC, Bonita R. Measuring accuracy of discharge diagnoses for a region-wide surveillance of hospitalized strokes. Stroke. 2005;36:1031–4.

    Article  PubMed  Google Scholar 

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Acknowledgments

Dr. Bonilha’s effort on this project was supported by a career development award (NIH/NCRR grant No. UL1 RR029880) from the South Carolina Translational Research Institute part of the NIH Clinical Translational Science Award Program.

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Authors and Affiliations

  1. Department of Health Sciences and Research, Medical University of South Carolina, 77 President St, Charleston, SC, 29425, USA

    Heather Shaw Bonilha, Charles Ellis & Bonnie Martin-Harris

  2. Evelyn Trammell Institute of Voice and Swallowing, Medical University of South Carolina, Charleston, SC, USA

    Heather Shaw Bonilha & Bonnie Martin-Harris

  3. Department of Otolaryngology – Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA

    Heather Shaw Bonilha, Annie N. Simpson & Bonnie Martin-Harris

  4. Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC, USA

    Annie N. Simpson & Kit Simpson

  5. Division of General Medicine and Geriatrics, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA

    Patrick Mauldin

  6. VA Center for Disease Prevention and Health Interventions for Diverse Populations, Ralph H. Johnson VA Medical Center, Charleston, SC, USA

    Bonnie Martin-Harris

Authors
  1. Heather Shaw Bonilha
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  2. Annie N. Simpson
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  3. Charles Ellis
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  4. Patrick Mauldin
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  5. Bonnie Martin-Harris
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  6. Kit Simpson
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Corresponding author

Correspondence to Heather Shaw Bonilha.

Additional information

Portions of this study have been presented at the annual American Speech-Language and Hearing Association convention, San Diego, California, November 2011 and the 20th Dysphagia Research Society annual meeting, Toronto, Canada, March 2012.

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Bonilha, H.S., Simpson, A.N., Ellis, C. et al. The One-Year Attributable Cost of Post-stroke Dysphagia. Dysphagia 29, 545–552 (2014). https://doi.org/10.1007/s00455-014-9543-8

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  • DOI: https://doi.org/10.1007/s00455-014-9543-8

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