# Direct medical cost of first-ever acute ischemic stroke in malaysia: a retrospective cohort study

## TL;DR

This study examines the direct medical costs of first-time ischemic strokes in Malaysia, highlighting factors like hospital stay and stroke type that influence expenses.

## Contribution

The study provides the first detailed analysis of inpatient costs for first-ever ischemic stroke in Malaysia's multiethnic population.

## Key findings

- Patients with poor functional status had higher average treatment costs (MYR 1,970.7) due to longer hospital stays and radiology expenses.
- Stroke subtype, length of stay, and functional status significantly affect medical costs, with PACI subtype incurring the highest costs.
- Reducing hospital stay and improving functional outcomes could lower the economic burden of first-time ischemic strokes.

## Abstract

Understanding the economic impact of first-ever stroke in a multiethnic population like Malaysia is essential for informed resource allocation. This study aimed to evaluate the direct medical costs associated with first-ever ischemic stroke in Malaysia. The study was a retrospective cohort study that estimated the inpatient direct medical costs of first-ever ischemic stroke in Malaysia. The study involved 122 adult patients managed at Hospital Sultanah Nur Zahirah, Terengganu (HSNZ), enrolled in the Malaysian National Stroke Registry (NSR) from 2009 to 2020. The mean ± standard deviation (SD) for the patients’ age was 61.0 ± 10.9 years, the length of stay (LOS) was 4.5 ± 3.5 days, and the modified Rankin scale (mRS) score was 3.0 ± 1.1. Most patients experienced functional disability (poor functional status, mRS ≥ 3) and incurred an average (SD) treatment cost of MYR 1,970.7 ± 1,385.8, primarily attributed to hospital admissions and radiology expenses. The medical costs were significantly lower in patients with good functional status [mRS < 3 (p = 0.002)] and shorter LOS (p < 0.001), but higher in patients with the partial anterior circulation infarct (PACI) stroke subtype (p < 0.001). Additionally, patients with good functional status incurred significantly lower costs for admission and medications (p < 0.001). In conclusion, the inpatient direct medical cost of first-ever ischemic stroke in Malaysia is substantial and is influenced by stroke subtypes, length of stay, risk factors, and functional status. Strategies to reduce the length of stay, comorbidities, and functional status can potentially reduce the economic burden of the first-ever acute ischemic stroke. These findings are crucial for guiding the optimal allocation of resources for stroke care.