To examine the expenditures among stroke survivors with and without multiple chronic conditions.

Stroke carries a heavy disease burden for patients and their families—both medically and financially. Although co-existing chronic conditions are frequent in stroke patients, their impact on health care expenditures has not been evaluated in stroke patients in the United States.

Data from the 2003-2014 Medical Expenditure Panel Survey (MEPS) were used to compute the individual yearly healthcare costs of stroke patients in the U.S. general non-institutionalized population. We examined unadjusted and adjusted (incremental) cost (total direct healthcare, inpatient, outpatient, prescription medication, emergency room (ER) visit, home healthcare, and others) of stroke according to the number of multiple chronic conditions, MCC (0, 1, 2 or more) based on the 2010 MCC Chartbook.  

During the study period, on average 7,585,187 adults reported a history of stroke per year, of which 5.9% had no chronic condition, 13.8% had one chronic condition, and 80.3% had ≥2 chronic conditions. Each adult with stroke had a yearly total unadjusted mean expenditure of $8,413 for zero chronic condition, $10,377 for one chronic condition and $17,260 for two or more chronic condition. Compared to patients without chronic conditions, patients with two or more chronic conditions had $4,357 higher total incremental expenditure, $1,537 higher outpatient expenditure, $215 higher ER expenditure, and $2,030 higher prescription medications expenditures. Overall, total incremental expenditure for stroke with two or more chronic conditions was $26.5 billion a year higher than those without any chronic condition.

In the United States, eight of ten individuals with a history of stroke have ≥2 chronic conditions, corresponding to high healthcare expenditures, driven primarily by inpatient costs. Early and sustained treatment of these co-morbid conditions, will likely result in lower expenditures, but even more importantly, better clinical outcomes for stroke survivors.