Objectives: Half of childhood ischemic stroke (CIS) survivors experience long-term impairments but the economic cost of CIS is poorly characterized. This study examined the economic burden, and the associated quality-adjusted life years (QALYs) and life years (LYs) lost among a national cohort of Australian CIS patients. Methods: A Markov cohort model was developed to quantify per-capita, national healthcare and societal costs of CIS. Associated lifetime loss of QALYs and LYs were determined for Australian CIS patients aged 1 month to 18 years. The model comprised seven health states using the modified Rankin scale (mRS, scores 0-6), adapted from previous modelling in adults. Key inputs including post-stroke outcome (i. e. mRS<90 days) and length of acute hospital stay were sourced from eight Australian representative tertiary children's hospitals between 2015 – 2017. Additional costing data on indirect costs, family out-of-pocket expenses, and education and disability services were obtained from published literature and government statistics. Extensive sensitivity analyses and model validation were conducted to assess the robustness of the results. Results: Based on data from 176 CIS patients (average age 8 years at onset), estimated per-capita costs are A111, 807 in healthcare, A131, 048 in indirect costs, A4, 948 in family out-of-pocket expenses, A479 in education system costs, and A9, 947 in National Disability Insurance Scheme costs. At the national level, the lifetime economic burden is approximately A14. 8 million from a healthcare perspective, and A33. 4 million from a societal perspective per year. Each CIS patient is associated with a loss of 33. 64 QALYs and 37. 82 LYs, compared to their counterparts without CIS (Table 1). Conclusions: This study provides the first comprehensive assessment of the economic burden of CIS in Australia, demonstrating the substantial impact of CIS on healthcare resources and quality of life. These findings highlight the need for better access to reperfusion therapies which minimize extent of brain injury and targeted rehabilitation strategies. These results may inform resource allocation and policy formulation to optimize care for childhood stroke survivors.
Mackay et al. (Thu,) studied this question.