In the EU, the total cost of stroke in 2015 was calculated as €45 billion. 44% of this amount, i.e. €20 billion, was caused by direct health care costs. 72% of direct health care costs were for in-hospital care and 7% for drugs. Figure 4 shows the direct health care costs of stroke per capita in 2015. For comparison, the crude incidence rate of stroke in 2015 (GBD 2015) is included in figure 4 and demonstrates that there is no association between national per-capita spending and the national rate of new strokes.
Direct health care cost per capita varied widely across the EU, from €132 in Finland to €7 in Bulgaria, or by a factor of 19. The overall health expenditure also varies between European countries and the proportions of overall health expenditure spent on stroke varied less between countries than the stroke-specific expenditure per capita: Finland and Hungary spent 4% of their total healthcare expenditure on stroke, while Denmark spent less than 1%. The amount of money spent on stroke therefore depends on the significantly different overall national healthcare budgets, but also on varying allocations within that budget.
Most studies measuring the cost of stroke only look at direct health care costs. This hugely underestimates the total cost of stroke because it does not take into account non-health care costs including informal care (the opportunity cost of unpaid care provided by family or friends), or productivity lost due to death or disability.
Informal care costs alone were estimated at €15.9 billion or 35% of the total cost of stroke in the eu in 2015. Productivity losses were estimated to be €5.4 billion or 12% for losses due to death and €4.0 billion or 9%, for losses due to morbidity.
The economic burden of stroke is borne by society as a whole via tax payments and insurance contributions, but significantly also by the individual stroke survivors and their families and friends. Figure 4 shows non-health care costs of stroke for EU countries in 2015, again in comparison with GBD estimates of stroke prevalence, i.e. the number of stroke survivors, in 2015.
As the number of strokes and the number of stroke survivors is expected to increase over the coming decades, the economic impact of stroke will need more attention with regards to effective health care planning and resource allocation as well as the financial burden borne by stroke survivors and their family and friends.
Figure 4: Health care and non-health care costs of stroke per capita in 2015 in euro and crude incidence and prevalence of stroke per 10,000 inhabitants in 2015 (GBd 2015)
As well as the economic impact of stroke, stroke survivors commonly experience a wide range of negative physical and mental consequences. These are often long-lasting and can have a large impact on the lives of patients and their families. Impaired mobility, vision, speech, depression, and cognitive impairments such as memory problems, personality changes, and fatigue are typical.
By their nature, the impacts of these impairments are complex and hard to quantify. There should be more research into patient-reported experience and outcome measures, and quality of life studies. SAFE believes that patients, carers, and patient organisations/SSOs should be actively involved in these studies as participants and co-researchers.
“My GP was the best, she was fantastic. [But] when it came to the real crunch of it, that big part down the line, I spoke to her and she hadn’t got a clue[about longer term support]. It’s like thinking, how do you educate the medical profession to better understand about the whole person’s needs? Because it all focuses around ‘treat them in the hospital, rehabilitation, get them out into the community, six weeks’ support … and then you’re on your own.’ ”
(Male stroke survivor, UK)
“There are a lot of things that I cannot do that I did before. I was fond of skiing – I cannot do that. I cannot ride a bicycle because I have no balance, and things like that. You miss it, but after some time you get used to it. It’s a new life; you have to adjust to what you can do.”
(Male stroke survivor, Norway)