Cost of a recurrent vs. cost of first‐ever stroke over an 18‐month period

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Abstract
When assessing the cost‐effectiveness of the secondary prevention of stroke, it is not well known whether the cost of a recurrent brain infarction (BI) is different from a first‐ever BI. In a cohort of 435 consecutive prevalent cases of BI (including both recurrent and first‐ever BI) we collected medical and socio‐economic variables. Handicap was measured with the Rankin scale. Only the direct medical costs were considered over an 18‐month period from a societal perspective. We compared first‐ever to recurrent BI. Of the 435 patients 20.5% had a recurrent BI. The length of the initial hospitalization and the distribution of the patients into the three classes of handicap (Rankin 0–2, 3, and 4–5) were similar in the first‐ever and recurrent BI groups. The average total cost of a first‐ever BI was €19 725 (95% CI, 17 950–21 501) and €18 560 (95% CI, 15 798–21 322) for a recurrent BI (P = 0.48). There were no differences between the two groups when the costs were compared by handicap levels (P = 0.17) or when the costs were compared for each type of expenditure (initial hospitalization, rehabilitation, ambulatory services) except for long‐term care, because of the small number of cases. This study suggests that the costs of recurrent BI are roughly similar to the costs of first‐ever BI, which may be helpful when studying the cost‐effectiveness of secondary stroke prevention trials.