How Much Does Dysphagia Cost? An Estimation of the Additional Annual Cost of Dysphagia in Patients Hospitalised with Stroke

INTRODUCTION: Stroke-related dysphagia poses a substantial challenge, both in terms of its prevalence and the economic costs associated with its management. Despite its significance, there is a lack of comprehensive studies focusing on the economic burden of stroke-related dysphagia in the New Zealand context. The aims of this research are to estimate the economic costs and quality of life of patients with stroke-related dysphagia in New Zealand, emphasising the importance of understanding and addressing this issue from a healthcare management perspective. METHODS: Secondary analysis of data from the REGIONS Care study, a New Zealand wide sample of all patients hospitalised with stroke within a 6-month period (between 1st May 2018 and 30th October 2018) including follow-up up to 12 months. Patients were identified as dysphagic if they received a swallow screen during hospital admission and were seen by a Speech Language Therapist (SLT). Severe dysphagia was identified if the patients had a nasogastric feeding tube during their hospital admission and were seen by an SLT. Optimal linear propensity score matching was utilised to acquire a better counterfactual group for dysphagic stroke patients. All cost estimates were converted to NZ$2021 to compare to existing literature. RESULTS: Of all patients with stroke in the REGIONs Care study, 40% (952/2,379) were identified as dysphagic and 5% (119/2,379) as severely dysphagic. Using these percentages and the total number of reported strokes in 2021/22 in New Zealand, we estimated that 3,588 were dysphagic and 449 were severely dysphagic. These stroke-related dysphagic patients in 2021 presented a total additional cost of $89.6 million to New Zealand society, or a marginal cost of $25,000 per dysphagic patient. This estimate includes the additional hospitalisation costs ($16,100), community rehabilitation services ($1,370), hospital-level aged residential care ($4,030) and reduced quality of life (QoL) over a 12-month period post-hospital admission ($3,470). The total marginal cost of severely dysphagic stroke -related patients was $19.9 million overall, or $44,300 per patient. DISCUSSION/CONCLUSION: The costs derived from the REGIONS Care study and the estimates of reduced QoL due to dysphagia provide a novel contribution for New Zealand, and internationally. While there is international literature estimating the marginal cost of dysphagic stroke-related hospitalisation, few extend this analysis to post-hospitalisation care and even fewer to the costs of reduced QoL. By quantifying this economic burden, we can advocate for improved dysphagia management strategies and ultimately enhance the overall quality of care for stroke survivors.