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Hospital treatment costs and length of stay associated with hypertension and multimorbidity after hemorrhagic stroke
Open accessAbstract
BACKGROUND: Previous studies have identified various treatment and patient characteristics that may be associated with higher hospital cost after spontaneous intracerebral hemorrhage (ICH); a devastating type of stroke. Patient morbidity is perhaps the least understood of these cost-driving factors. We describe how hypertension and other patient morbidities affect length of stay, and hospital treatment costs after ICH using primary and simulated data. We also describe the relationship between cost and length of stay within these patients. METHODS: We used a cohort design; evaluating 987 consecutive ICH patients across one decade in a Canadian center. Economic, treatment, and patient data were obtained from clinical and administrative sources. Multimorbidity was defined as the presence of one or more diagnoses at hospital admission in addition to a primary diagnosis of ICH. RESULTS: Hypertension was the most frequent (67%) morbidity within these patients, as well as the strongest predictor of longer stay (adjusted RR for >7 days: 1.31, 95% CI: 1.07-1.60), and was significantly associated with higher cost per visit when accounting for other morbidities (adjusted cost increase for hypertension $8123.51, 95% CI: $4088.47 to $12,856.72 USD). A Monte Carlo simulation drawing one million samples of patients estimated for a generation (100 years) assuming 0.94% population growth per year, and a hospitalization rate of 12 per 100,000 inhabitants, supported these findings (p = 0.516 for the difference in unadjusted cost: simulated vs primary). Using a restricted cubic spline, we observed that the rate of change in overall cost for all patients was greatest for the first 3 weeks (p < 0.001) compared to subsequent weeks. CONCLUSION: Patient multimorbidity, specifically hypertension, is a strong predictor of longer stay and cost after ICH. The non-linear relationship between cost and time should also be considered when forecasting healthcare spending in these patients.
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The initial days of a hospital stay are more expensive than later days.
“Second, the initial days of a stay in the hospital are more expensive than the later days (Taheri, Butz, and Greenfield 2000;Specogna et al. 2017)”
From Estimating the Cost of Alternate Level of Care When It Is Inextricably Linked to the Cost of Acute Care: A Canadian Example (2026) · cites this paper as Specogna et al. 2017
The Discussion says the greatest costs per day after intracerebral hemorrhage (ICH) are likely incurred on the first day and may decline over time; the Results also describe a nonlinear cost pattern. The citing sentence presents this as a general, unqualified fact about hospital stays, whereas the paper limits and hedges its finding to ICH care. Page numbers were not supplied in our copy. (LLM, conf=0.86)
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Validation of a case definition to define hypertension using administrative data
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“Decisions for morbidity classification and stratification were informed from previous investigations [2, 10, 11] (Table 1).”
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Research works printed but not linked: 18
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Basu, K. (2026) · Hospital Topics · doi:10.1080/00185868.2025.2474761 · Cited by 3
“Second, the initial days of a stay in the hospital are more expensive than the later days (Taheri, Butz, and Greenfield 2000; Specogna et al. 2017) and the average cost of per-day acute care is more expensive than ALC.”
Metadata
- Authors
- Specogna, A. V., Turin, T. C., Patten, S. B., & Hill, M. D.
- Affiliations
- University of Central Florida (US)
- University of Calgary (CA)
- Foothills Medical Centre (CA)
- Corresponding author
- Specogna, Adrian V.
- Venue
- BMC Neurology
- Published
- 2017-08-10
- Volume
- 17
- Issue
- 1
- Pages
- 158-158
- ISSN
- 1471-2377 (ISSN-L)
- PMC
- PMC5553779
- OpenAlex
- W2745043308
- Cited by
- 45
- References
- 1
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 1 · 2023: 6 · 2022: 3 · 2021: 10 · 2020: 7 · 2019: 7 · 2018: 3
- FWCI
- 3.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Neurology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Journal of International Crisis and Risk Communication Research (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Libraries and Cultural Resources (University of Calgary) (submittedVersion)
- Funders
- University of Calgary
- Topics
- Health Sciences › Medicine › Clinical Neurology › Intracerebral and Subarachnoid Hemorrhage Research
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Medicine › Clinical Neurology › Acute Ischemic Stroke Management
- Keywords
- intracerebral hemorrhage, hemorrhagic stroke, hospital costs, length of hospital stay, hypertension, multimorbidity, health care spending, Monte Carlo simulation
- MeSH terms
- Multimorbidity, Adult, Aged, Aged, 80 and over, Canada, Cerebral Hemorrhage, Female, Hospitalization, Hospitals, Humans, Hypertension, Length of Stay, Male, Middle Aged, Retrospective Studies, Health Care Costs, Stroke, Young Adult
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