Health-Economic Implications of Post-Stroke Dysphagia: A Contemporary Medicare Claims Analysis

INTRODUCTION: Post-stroke dysphagia is associated with increased healthcare costs and resource utilization. This analysis sought to evaluate acute clinical and economic outcomes among patients with stroke, with and without post-stroke dysphagia, and other associated sequelae. METHODS: A retrospective analysis of Medicare inpatient claims was conducted. The analysis sample included patients with a diagnosis of acute ischemic (AIS) and hemorrhagic (intracerebral hemorrhage, ICH) stroke, with or without subsequent post-stroke complications of dysphagia, pneumonia, and percutaneous endoscopic gastrostomy (PEG) placement. The primary outcomes were total length of stay (LOS) and intensive care unit (ICU), days, costs (derived from charges using cost-to-charge ratios), reimbursement, and discharge destination. Regression analyses explored the relationship between LOS and cost for patients with dysphagia and AIS or ICH. RESULTS: A total of 595,903 patients with AIS or ICH stroke (N = 474,634 AIS and N = 95,020 ICH) were included, with dysphagia (13.0%), pneumonia (13.1%), and PEG placement (4.8%) as some of the most common complications. Patients with AIS and ICH stroke and a post-stroke diagnosis had higher LOS and longer ICU utilization (+ 4.48 and + 6.28 days, respectively, including + 2.04 and + 3.76 days in the ICU) and higher total costs (+ $11,030 and + $18,289). These increases in LOS and cost were even more pronounced for patients with pneumonia (hospital LOS + 10.09 days; ICU LOS + 6.26 days); and PEG placement (hospital LOS + 17.85 days; ICU LOS + 10.35 days). Of those with a dysphagia diagnosis, 61.1% and 64.9% fewer patients with AIS and ICH could be discharged to home/self-care. Costs exceeded reimbursement for all groups analyzed. CONCLUSIONS: In this claims data analysis of patients treated for acute ischemic and hemorrhagic stroke, higher resource utilization and costs were observed in patients with dysphagia and related post-stroke complications. Efforts to improve the management of post-stroke complications may result in significant clinical and economic benefits for payers and providers.