Analysis of Direct Medical Costs of Acute Stroke among Patients in a Tertiary Hospital in Ibadan, South-West, Nigeria

Abstract

Background: The medical costs of treating acute stroke represent a major burden for patients, especially in countries where out-of- pocket (OOP) payment is a major source of health care financing. This study used a micro-costing approach to estimate the direct costs of  acute episode of stroke among 175 patients admitted between February and May 2015 in a tertiary hospital in Ibadan, Nigeria.

Methods: A 10% threshold with patients’ household annual per capita income was used to ascertain the incidence of catastrophic health  expenditure (CHE) among patients. A patient incurred CHE if the OOPs exceeded 10% of the annual per capita income of the households  where they live. Bivariate analysis was carried out to evaluate the association between CHE and patient-level clinical characteristics.

Findings: Male respondents were 118 (67.4%), and the mean age of respondents was 60.9 ±13.7 years. A total of 156 (89.1%) respondents  paid for their medical services through OOPs, while 19 (10.9%) paid through social health insurance. The average health care expenditure  on acute stroke treatment for respondents who made OOPs was ₦195,672.20±₦170,661.30 and ₦189,817.40±₦77,114.00 for  those whose OOPs was partly offset by social health insurance. The average annual income of the respondents was ₦696,685.70± ₦69.834.80 Expenditure on admission/consultation, and radiological services represent the highest costs contributing to patients’ average direct medical cost, ₦30,822.90 ($154.89) and ₦43,200 ($217.09), respectively. This was followed by expenditure on drugs  ₦27,088.00 ($136.12). Overall, 29.1% of the respondents experienced CHE, of these, 94.1% used out-of-pocket, and 5.9% had some form of  social health insurance. The incidence of CHE was significantly associated with low educational status, length of hospital stay, and co- morbidity.

Conclusion: Acute stroke patients experienced catastrophic health expenditure largely due to huge drugs and laboratory fees.  Increasing financial risk protection for these patients would prevent them from impoverishment as a result of enormous medical  costs.