Assessing the cost of acute stroke care in Ethiopian public tertiary hospitals: a multicenter study

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Background: The cost of acute stroke data is scarce in developing countries, especially Ethiopia, despite its significance for public health. This study aimed to assess the total cost of acute stroke care per patient per year among acute stroke patients admitted to tertiary hospitals in Addis Ababa, Ethiopia. Methods: An incidence-based, prospective, cross-sectional cost-of-illness study was conducted among 99 acute stroke survivors admitted to two specialized hospitals in Addis Ababa. A micro-costing technique was applied to pinpoint cost-generating elements and assign the proper unit costs for the two cost categories, direct and indirect. A multivariable generalized linear model was employed to identify predictors of acute-phase costs among stroke patients. Results: The median cost of acute stroke care per patient per year was $286, with direct and indirect costs of $193.77 and $74, respectively. Between-group cost differences were primarily driven by delayed hospital presentation (arrival >4.5 h after symptom onset; adjusted cost ratio [CR] 1.78), ICU admission (CR 1.56), older age (CR 1.27), at least one comorbid condition (CR 1.27), and rural residence (CR 1.40). Conclusion: The costs of acute stroke care in public tertiary hospitals in Ethiopia are very high, with over 30% of GDP per capita spent on acute stroke care. Understanding the cost of stroke in Ethiopia is critical for planning the implementation of acute care services, including stroke treatments, under universal health coverage, ensuring that all stroke patients benefit.

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