Cost of Illness of Hospitalized Ischemic Stroke Patients on Antihypertensive Therapy: BPJS Ward Class and Time to Blood Pressure Target

Ischemic stroke is a catastrophic disease that burdens Indonesia’s National Health Insurance, and hypertension is its main modifiable risk factor. This study aimed to analyze the cost of illness, measured as total inpatient cost, of BPJS-insured ischemic stroke patients receiving antihypertensive therapy according to ward class and therapy model, and to describe the time needed to reach a blood pressure target of ≤140/90 mmHg. This retrospective cohort study used medical records and billing data of ischemic stroke inpatients at Dr. Pirngadi Regional General Hospital Medan from January 2023 to December 2024 (n=37; cost analysis n=36). Kruskal-Wallis, Mann-Whitney U, and Spearman correlation tests were applied. The median total inpatient cost is IDR 3,607,050 (range IDR 1,644,500–66,808,955) with a right-skewed distribution. Costs do not differ significantly across ward classes (p=0.101), therapy models (p=0.144), or drug classes (p=0.245); a sensitivity analysis excluding one extreme value indicates that class 1 tends to have the highest cost (p=0.048). No patient reaches the target on the first day; 40.5% reach it within 2 days, 29.7% on day 3, 13.5% after day 3, and 16.2% do not reach it during hospitalization. Total cost shows a moderate positive correlation with length of stay (rho=0.552; p<0.001) but not with time to blood pressure target (rho=−0.066; p=0.724). The inpatient cost burden of ischemic stroke under BPJS is determined more by length of stay than by antihypertensive drug class or the speed of blood pressure control; therefore, cost-containment efforts should focus on safely shortening hospital stay.