Direct Medical Cost for Acute Ischemic Stroke Patients in Vietnam

Main Article Content

Tuan Van Nguyen
Minh Van Hoang
Huyen Thi Doan
Van Minh Nguyen

Abstract

Ischemic stroke is one of the leading causes of global disease burden. Vietnam, among other low- and middle-income countries, bears nearly 90% of the ischemic stroke burden. This study was a cost-of-illness study conducted from the healthcare system perspective to estimate the direct medical costs and associated factors for acute ischemic stroke patients at Bach Mai Hospital, a major hospital in Hanoi, Vietnam. A total of 500 eligible patients with acute ischemic stroke at the Neurology Department of Bach Mai Hospital from July 2021 to December 2021 were included. Patient characteristics and treatment information were collected via medical records and patient interviews. The majority of the patients were men (65.8%), with a mean age of 65.3 years. The average direct medical cost per patient was 10.5 ± 7.3 million Vietnam Dong (~454.2 ± 313.8 US dollars). The cost of hospital beds accounted for most of the total cost (34.6%), followed by medications and infusion fluid costs (27%) and diagnostic imaging (12.6%). Factors significantly associated with higher direct medical costs were the duration of stay, stroke severity, complications, number of comorbidities, and intravenous thrombolysis treatment. The study highlighted the need for a reduction in the duration of hospital stay and an improvement in onset-to-hospital arrival time.

Article Details

How to Cite
Nguyen, T. V., Hoang, M. V., Doan, H. T. ., & Nguyen, V. M. (2024). Direct Medical Cost for Acute Ischemic Stroke Patients in Vietnam. Journal of Population and Social Studies [JPSS], 32, 781–793. Retrieved from https://so03.tci-thaijo.org/index.php/jpss/article/view/272807
Section
Research Articles
Author Biography

Van Minh Nguyen, Hanoi University of Public Health, Hanoi, Vietnam

Corresponding author

References

• Abdo, R., Abboud, H., Salameh, P., Jomaa, N. A., Rizk, R., & Hosseini, H. (2018). Direct medical cost of hospitalization for acute stroke in Lebanon: A prospective incidence-based multicenter cost-of-illness study. Inquiry, 55. https://doi.org/10.1177/0046958018792975

• Ashraf, V., Maneesh, M., Praveenkumar, R., Saifudheen, K., & Girija, A. S. S. (2015). Factors delaying hospital arrival of patients with acute stroke. Annals of Indian Academy of Neurology, 18(2), 162–166. https://doi.org/10.4103/0972-2327.150627

• Carr, C., Kahn, L., Mathkour, M., Biro, E., Bui, C. J., & Dumont, A. S. (2018). The shifting burden of neurosurgical disease: Vietnam and the middle-income nations. Neurosurgical Focus, 45(4), Article E12. https://doi.org/10.3171/2018.7.focus18297

• Chow, W. L., Tin, A. S., & Meyyappan, A. (2010). Factors influencing costs of inpatient ischaemic stroke care in Singapore. Proceedings of Singapore Healthcare, 19(4), 283–291. https://doi.org/10.1177/201010581001900402

• Công, N. H. (2007). Stroke care in Vietnam. International Journal of Stroke, 2(4), 279–280. https://doi.org/10.1111/j.1747-4949.2007.00149.x

• Fang, J., Yan, W., Jiang, G.-X., Li, W., & Cheng, Q. (2011). Time interval between stroke onset and hospital arrival in acute ischemic stroke patients in Shanghai, China. Clinical Neurology and Neurosurgery, 113(2), 85–88. https://doi.org/10.1016/j.clineuro.2010.09.004

• Feigin, V., Stark, B., Johnson, C. O., Roth, G. A., Bisignano, C., Gebreheat, G., Abbasifard, M., Abbasi‐Kangevari, M., Abd‐Allah, F., Abedi, V., Abualhasan, A., Abu-Rmeileh, N. M. E., Abushouk, A. I., Adebayo, O., Agarwal, G., Agasthi, P., Ahinkorah, B. O., Ahmad, S., Ahmadi, S., . . . Murray, C. J. L. (2021). Global, regional, and national burden of stroke and its risk factors, 1990–2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurology, 20(10), 795–820. https://doi.org/10.1016/s1474-4422(21)00252-0

• General Statistics Office (GSO). (2022, June 9). Kết Quả Khảo Sát Mức Sống Dân Cư Việt Nam Năm 2020 [Result of the Vietnam Household Living Standards Survey 2020]. https://www.gso.gov.vn/en/data-and-statistics/2022/06/results-of-the-viet-nam-household-living-standards-survey-2020/

• Le, T. N., Nguyen, T. T., Nguyen, H. T., & Nguyen, N. H. (2016). Inpatient treatment cost of stroke: An analysis in Ho Chi Minh City 115 People’s Hospital, Vietnam. Value in Health, 19(7), Article A649. https://doi.org/10.1016/j.jval.2016.09.1742

• Lee, E.-J., Kim, S. J., Bae, J., Lee, E. J., Kwon, O. D., Jeong, H.-Y., Kim, Y., & Jeong, H.-B. (2021). Impact of onset-to-door time on outcomes and factors associated with late hospital arrival in patients with acute ischemic stroke. PLOS ONE, 16(3), Article e0247829. https://doi.org/10.1371/journal.pone.0247829

• Matsuo, R., Yamaguchi, Y., Matsushita, T., Hata, J., Kiyuna, F., Fukuda, K., Wakisaka, Y., Kuroda, J., Ago, T., Kitazono, T., & Kamouchi, M. (2017). Association between onset-to-door time and clinical outcomes after ischemic stroke. Stroke, 48(11), 3049–3056. https://doi.org/10.1161/strokeaha.117.018132

• Ministry of Health. (2018, November 30). Unifying prices of medical examination and treatment services covered by medical insurance among hospitals of the same class across the country and guidelines for applying prices and payment for medical services in certain cases (No. 39/2018/TT-BYT). https://thuvienphapluat.vn/van-ban/EN/Bao-hiem/Circular-39-2018-TT-BYT-unifying-prices-of-medical-examination-services-covered-by-medical-insurance/403786/tieng-anh.aspx

• Ministry of Health. (2022, November 5). Mỗi năm Việt Nam có khoảng 200.000 ca đột quỵ, nhiều người trẻ tuổi mắc bệnh nguy hiểm này [Vietnam has 200,000 cases of stroke each year and younger people are having this dangerous disease]. https://moh.gov.vn/tin-noi-bat/-/asset_publisher/3Yst7YhbkA5j/content/moi-nam-viet-nam-co-khoang-200-000-ca-ot-quy-nhieu-nguoi-tre-tuoi-mac-benh-nguy-hiem-nay

• Ngo, T. T. D., Nguyen, T. N., Nguyen, T. K. L., & Pham, T. L. (2012). Chi Phí Điều Trị Đột Quỵ Tại Khoa Bệnh Lý Mạch Máu Não Bệnh Viện Nhân Dân 115 Thành Phố Hồ Chí Minh [Total costs for acute stroke in a major hospital in Ho Chi Minh City]. Ho Chi Minh City Journal of Medicine, 16(1), 133–141. https://tapchiyhoctphcm.vn/articles/10421

• Nguyen, H. L. (2022). Phân Tích Chi Phí Phục Hồi Chức Năng Tại Nhà Cho Những Người Khuyết Tật Sau Đột Quỵ Ở Thành Phố Huế [Cost analysis of home based rehabilitation for the disabled after stroke in Hue city]. Hue Journal of Medicine and Pharmacy, 7(1), 59–63. https://doi.org/10.34071/jmp.2017.1.9

• Nguyen Q. A., & Vo V. T. (2021). Chi phí trực tiếp cho đợt điều trị nội trú nhóm bệnh đột quỵ cấp tại khoa Nội thần kinh, bệnh viện Nhân dân Gia Định năm 2020 và một số yếu tố ảnh hưởng [Direct medical cost and its associated factors for inpatient treatment of stroke patients at Neurology Department, Gia Dinh People’s Hospital in 2020]. Journal of Health and Development Studies, 5(3), Article 3. https://doi.org/10.38148/JHDS.0503SKPT20-121

• Pham, T. L. (2015). Occurrence, presentation, costs and three-month outcomes of stroke in Viet Nam [Doctoral dissertation, University of Tasmania]. https://doi.org/10.25959/23239280.v1

• Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O., Bambakidis, N. C., Becker, K. J., Biller, J., Brown, M. D., Demaerschalk, B. M., Hoh, B. L., Jauch, E. C., Kidwell, C. S., Leslie‐Mazwi, T. M., Ovbiagele, B., Scott, P., Sheth, K. N., Southerland, A. M., Summers, D., & Tirschwell, D. (2019). Guidelines for the early management of patients with acute ischemic stroke: 2019 Update to the 2018 guidelines for the early management of acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 50(12), e344–e418. https://doi.org/10.1161/str.0000000000000211

• Raghupathi, V., & Raghupathi, W. (2020). Healthcare expenditure and economic performance: Insights from the United States data. Frontiers in Public Health, 8, Article 156. https://doi.org/10.3389/fpubh.2020.00156

• Sribundit, N., Riewpaiboon, A., Chaikledkaew, U., Stewart, J. F., Tantirittisak, T., & Hanchaipiboolkul, S. (2017). Cost of acute care for ischemic stroke in Thailand. Southeast Asian Journal of Tropical Medicine and Public Health, 48(3), 628–640. https://www.tm.mahidol.ac.th/seameo/2017-48-3/14-69639-628.pdf

• Stracker, N., Hanrahan, C., Mmolawa, L., Nonyane, B., Tampi, R., Tucker, A., West, N., Lebina, L., Martinson, N., & Dowdy, D. (2019). Risk factors for catastrophic costs associated with tuberculosis in rural South Africa. The International Journal of Tuberculosis and Lung Disease, 23(6), 756–763. https://doi.org/10.5588/ijtld.18.0519

• Strilciuc, Ș., Grad, D. A., Radu, C., Chira, D., Stan, A., Ungureanu, M., Gheorghe, A., & Muresanu, F.-D. (2021). The economic burden of stroke: A systematic review of cost of illness studies. Journal of Medicine and Life, 14(5), 606–619. https://doi.org/10.25122/jml-2021-0361

• Tong, D., Reeves, M. J., Hernandez, A. F., Zhao, X., Olson, D. M., Fonarow, G. C., Schwamm, L. H., & Smith, E. E. (2012). Times from symptom onset to hospital arrival in the Get With The Guidelines-Stroke Program 2002 to 2009: Temporal trends and implications. Stroke, 43(7), 1912–1917. https://doi.org/10.1161/STROKEAHA.111.644963

• United Nations Fund for Population Activities (UNFPA). (2011, July). The ageing population in Viet Nam: Current status, prognosis, and possible policy responses. https://vietnam.unfpa.org/en/publications/ageing-population-viet-nam-current-status-prognosis-and-possible-policy-responses

• van Swieten, J. C., Koudstaal, P. J., Visser, M. C., Schouten, H. J., & van Gijn, J. (1988). Interobserver agreement for the assessment of handicap in stroke patients. Stroke, 19(5), 604–607. https://doi.org/10.1161/01.STR.19.5.604

• Verguet, S., Riumallo-Herl, C., Gomez, G. B., Menzies, N. A., Houben, R. M. G. J., Sumner, T., Lalli, M., White, R. G., Salomon, J. A., Cohen, T., Foster, N., Chatterjee, S., Sweeney, S., Baena, I. G., Lönnroth, K., Weil, D. E., & Vassall, A. (2017). Catastrophic costs potentially averted by tuberculosis control in India and South Africa: A modelling study. The Lancet Global Health, 5(11), e1123–e1132. https://doi.org/10.1016/S2214-109X(17)30341-8

• The World Bank. (2022). Official exchange rate (LCU per US$, period average) - Viet Nam [Dataset]. https://data.worldbank.org/indicator/PA.NUS.FCRF?locations=VN

• The World Bank. (2024). World Development Indicators: Popular Indicators [Dataset]. https://databank.worldbank.org/indicator/NY.GDP.PCAP.CD/1ff4a498/Popular-Indicators

• Xu, K., Saksena, P., & Holly, A. (2011, December). The determinants of health expenditure: A country-level panel data analysis. World Health Organization. https://www.r4d.org/wp-content/uploads/TransisitionsInHealthFinancing_DeterminantsofExpenditures.pdf

• Zhang, H., Yin, Y., Zhang, C., & Zhang, D. (2019). Costs of hospitalization for stroke from two urban health insurance claims data in Guangzhou City, southern China. BMC Health Services Research, 19(1), Article 671. https://doi.org/10.1186/s12913-019-4530-2