Document Type





Objective:To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan.It is also an important factor in development of public health policies and medical insurance plans. Average nnual income in Pakistan is 4881 rupees (U$ 85).
Methods: Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from 1998-2001 at The Aga Khan University Hospital (AKUH), Karachi. Acute stroke care at AKUH usually includes routinelaboratory investigation including Lipid profile, Magnetic resonance imaging/angiography (MRI/MRA),Echocardiogram, Carotid Doppler's ultrasound and medical management in the Stroke care unit.
Results:443 patients were included in study. Age range was 25-98 years (Mean 58 years). 269 (61%) were male. Length of hospital staywas 1 day; 67 patients, 2 days; 83 patients, 3 days; 70 patients, 4-5 days; 87patients, 6-10 days; 75 patients, 11-30 days; 49 patients and more than 30 days; 12 patients. Average length ofstay was five days and median length was three days. Average total cost was 70,714 rupees (U$1179) whichincluded average radiology cost; 12,507 rupees (U$ 208), average laboratory cost; 8365 rupees (U$139),average pharmacy cost; 13,320 rupees (U$222) and average bed/room charges; 27, 552 rupees (U$459).Length of hospital stay is the most important determinant of cost. Average total cost for patients who stayed for1 day was 19,597 rupees (U$ 326), 2-3 days; 25,568 rupees (U$426), 4-7 days; 49,705 rupees (U$828), 8-30 days; 153,586 rupees (U$2559), more than 30 days; 588,239 rupees (U$9804). Average cost for general wardwas 60,574 rupees (U$1010), private ward was 74,880 rupees (U$1248) and intensive care unit was 155,010rupees (U$2583).
Conclusion: Cost of acute stroke care is extremely high as compared to average national income at ourhospital. Most important determinant of cost is length of hospital stay. Cost cutting measures and increasedfunding from state are necessary to increase the availability of acute stroke care (JPMA 53:552;2003).


Journal of Pakistan Medical Association