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Short- and long-term health care resource utilization and costs following intracerebral hemorrhage

Fernando SM, Qureshi D, Talarico R, Dowlatshahi D, Sood MM, Smith EE, Hill MD, McCredie VA, Scales DC, English SW, Rochwerg B, Tanuseputro P, Kyeremanteng K. Neurology. 2021; 97(6):e608-18. Epub 2021 Jun 9. DOI:

Objective — We sought to evaluate the short- and long-term resource utilization and costs associated with ICH, taken from an entire population. We additionally sought to evaluate the association of oral anticoagulation (OAC) and healthcare costs.

Methods — Retrospective cohort study of adult patients (≥18 years) with ICH in the entire population of Ontario, Canada (2009-2017). We captured outcomes through linkage to health administrative databases. We used generalized linear models to identify factors associated with total cost. Analysis of OAC use was limited to patients ≥ 66 years. The primary outcome was total 1-year direct healthcare costs in 2020 US dollars.

Results — Among 16,248 individuals with ICH (mean age: 71.2 years, male: 52.3%), 1-year mortality was 46.0%, and 24.2% required mechanical ventilation. The median total 1-year cost was $26,886 [(interquartile range [IQR]) 9,641-62,907] with costs for those who died in hospital of $7,268 (IQR 4,031-14,966) versus $44,969 (IQR 20,264-82,414, P < 0.001) for survivors to discharge. Oral anticoagulation (OAC) use (analysis limited to individuals ≥ 66 years old) was associated with higher total 1-year costs (cost ratio 1.06 [95% confidence interval: 1.01-1.11]). Total 1-year costs for the entire cohort exceeded $120 million per year over the study period.

Conclusions — ICH is associated with significant healthcare costs, and the median cost of an ICH patient is roughly 10-times the median inpatient cost in Ontario. Costs were higher among survivors than deceased patients. OAC use is independently associated with increased costs. In order to maximize cost-effectiveness, future therapies for ICH must aim to reduce disability, and not only improve mortality.