Background: The economic burden of stroke is considerable. While studies on the costs of acute stroke treatment have been undertaken in Germany, thorough analysis of direct and indirect long-term costs is lacking.
Patients and methods: A hospital-based cohort of 151 consecutive patients with stroke or transient ischemic attacks (TIA) was followed up (medical examination and interview) at the end of the 4th year following the cerebrovascular event. Costs were calculated using a bottom-up approach and classified into direct medical and nonmedical costs, indirect costs, and patients' costs.
Results: Non-stroke-related costs (mean +/- standard deviation 4,610+/-9,310 Euros/person) were separated from total costs. Total stroke-related costs of the 4th year after stroke/TIA amounted to 7,670+/-10,250 Euros per person. The cost components were as follows: direct costs 56% (4,320+/-5,740 Euros), indirect costs 31% (2,350+/-2,710 Euros), and patients' payments 13% (1,000+/-4,100 Euros). The annual nationwide costs for the 4th year following stroke or TIA amounted to approximately 3 billion Euros.
Conclusion: The considerable size of long-term costs after stroke/TIA is mainly due to direct costs and poses an economic challenge to the German health care system. Patients contribute in a relevant way by their own payments.