Healthcare costs of post-stroke oropharyngeal dysphagia and its complications: malnutrition and respiratory infections

Background and purpose The healthcare economic costs of post-stroke oropharyngeal dysphagia (OD) are not fully understood. The purpose of this study was to assess the acute, subacute and long-term costs related to post-stroke OD and its main complications (malnutrition and respiratory infections). Methods A cost of illness study of patients admitted to Mataro Hospital (Catalonia, Spain) from May 2010 to September 2014 with a stroke diagnosis was performed. OD, malnutrition and respiratory infections were assessed during hospitalization and follow-up (3 and 12 months). Hospitalization and long-term costs were measured from hospital and healthcare system perspectives. Multivariate linear regression analysis was performed to assess the independent effect of OD, malnutrition and respiratory infections on healthcare costs during hospitalization, and at 3 and 12 months' follow-up. Results In all, 395 patients were included of whom 178 had OD at admission. Patients with OD incurred major total in-hospital costs (euro5357.67 +/- euro3391.62 vs. euro3976.30 +/- euro1992.58, p < 0.0001), 3-month costs (euro8242.0 +/- euro5376.0 vs. euro5320.0 +/- euro4053.0, p < 0.0001) and 12-month costs (euro11,617.58 +/- euro12,033.58 vs. euro7242.78 +/- euro7402.55, p < 0.0001). OD was independently associated with a cost increase of euro789.68 (p = 0.011) during hospitalization and of euro873.5 (p = 0.084) at 3 months but not at 12 months. However, patients with OD who were at risk of malnutrition or malnourished and suffered respiratory infections incurred major mean costs compared with those patients without OD (euro19,817.58 +/- euro13,724.83 vs. euro7242.8 +/- euro7402.6, p < 0.0004) at 12 months' follow-up. Conclusion Oropharyngeal dysphagia causes significant high economic costs during hospitalization that strongly and significantly increase with the development of malnutrition and respiratory infections at long-term follow-up.