Abstract WP026: Health-economic implications of dysphagia in the treatment of stroke patients of different etiology: Insights from a contemporary claims data analysis

Introduction: Dysphagia is a common post-stroke complication that is associated with increased healthcare resource utilization and costs. This analysis quantified the short-term incremental costs and clinical outcomes among stroke patients with and without dysphagia and other stroke sequelae, based on contemporary claims data. Methods: Data from the 2023 Medicare Provider Analysis and Review (MEDPAR) dataset were utilized to construct a sample of relevant ischemic stroke (IS) and hemorrhagic stroke (ICH) patients, with further stratification by the presence or absence of complications including dysphagia, pneumonia, and PEG/NG tube, based on ICD-10 diagnosis codes. The primary outcomes evaluated were total acute and ICU length of stay (LoS), costs (cost estimate derived from charges using hospital-specific cost-to-charge ratios), reimbursement, and discharge destination. Costs are reported in 2023 USD. A regression analysis was conducted, analyzing the relationship among LoS and cost for patients with both dysphagia and IS or ICH. Results: The total analysis sample included N=595,903 patients (N=474,634 IS and N=95,020 ICH), with mean total LoS of 7.55 days (7.19 IS, 9.59 ICH), thereof 3.11 (2.81 IS, 4.91 ICH) ICU days. Mean costs and reimbursement were $25,454 ($23,897 IS, $33,536 ICH) and $20,405 ($18,669 IS, $27,585 ICH), respectively. Dysphagia was identified in 13.0% (N=77,296) of the overall sample, with resulting incremental LoS and ICU days of +4.9 (10.39 vs. 5.49), +2.39 (4.21 vs. 1.82), +$12,276 (+$11,030 vs. +$18,289), and $8,186 ($7,588 vs. $12,287) , compared to stroke patients with none of the studied complications (70.1% of the sample, N=417,874). The incremental costs and resource utilization associated with pneumonia and PEG/NG tubes were even greater (see Figure 1). Estimated headroom (reimbursement minus cost) remained negative across all groups analyzed. Patients with dysphagia were more likely to be discharged to skilled nursing or inpatient rehabilitation facilities. Conclusions: Recent acute hospital data from the Medicare population suggest dysphagia is associated with a pronounced increase in costs and resource utilization in both ischemic and hemorrhagic stroke. Continued efforts are warranted to reduce the clinical and economic burden of dysphagia in this population.