Socioeconomic Costs of Stroke in Korea:
Estimated from the Korea National Health Insurance Claims Database
Seung-ji Lim, Han-joong Kim1), Chung-mo Nam1), Hoo-sun Chang2), Young-Hwa Jang, Sera Kim3), Hye-Young Kang2,3) Department of Public Health, Yonsei University Graduate School, Department of Preventive Medicine and Public Health, Yonsei University College of Medicine1), Graduate School of Public Health, Yonsei University2),Institute of Health Services Research, Yonsei
University3), Health Insurance Review and Assessment Service4)
Objectives : To estimate the annual socioeconomic costs of stroke in Korea in 2005 from a societal perspective.
Methods : We identified those 20 years or older who had at least one national health insurance (NHI) claims record with a primary or a secondary diagnosis of stroke (ICD-10 codes: I60-I69, G45) in 2005. Direct medical costs of the stroke were measured from the NHI claims records. Direct non-medical costs were estimated as transportation costs incurred when visiting the hospitals. Indirect costs were defined as patients and caregivers productivity loss associated with office visits or hospitalization. Also, the costs of productivity loss due to premature death from stroke were calculated.
R e s u l t s : A t o t a l o f 8 8 2 , 1 4 3 s t r o k e p a t i e n t s w e r e identified with prevalence for treatment of stroke at 2.44%. The total cost for the treatment of stroke in the nation was estimated to be 3,737 billion Korean won (KRW) which
included direct costs at 1,130 billion KRW and indirect costs at 2,606 billion KRW. The per-capita cost of stroke was 3 million KRW for men and 2 million KRW for women. The total national spending for hemorrhagic and ischemic stroke was 1,323 billion KRW and 1,553 billion KRW, respectively, which together consisted of 77.0% of the total cost for stroke. Costs per patient for hemorrhagic and ischemic stroke were estimated at 6 million KRW and 2 million KRW, respectively.
Conclusions : Stroke is a leading public health problem in Korea in terms of the economic burden. The indirect costs were identified as the largest component of the overall cost.
J Prev Med Public Health 2009;42(4):251-260 Key words : Cost of illness, Costs, Illness burden,
Preven-tion, Stroke 1 [1], [2,3]. 5 5 [4]. [5], , 2005 48.6 [6]. , [7], , [8]. (cost-of-illness study) . , [9-11], [12,13], [14], [15,16], [17], [18] . [19,20], [21] . ,
. (prevalence-based approach) (incidence-based approach) . . , , . , [22]. , . [23] [24] [25], [26] , 5 [27] . 2005 . , (ischemic stroke) 24 , 24 (TIA), , , . , , TIA [9,14]. ,
International Classification of Diseases 10th version (ICD-10) I60-I69 ,
ICD-10 G45 . 1 . 2005 ( ) (ICD-10 : I60-I69, G45) 1 1 20 . . . (ICD-10 : I20-I25) . 10 2 (ICD-10 : C00-C97, D00-D09) 1 8,710 . (hemorrhagic stroke) (ischemic stroke) ,
ICD-10 I60-I62 , ICD-10
(hemorrhagic stroke) . , . . , 2005 . (incidence-based approach) . . , [14] (cerebral infarction, CI),
(intracerebral haemorrhage, ICH), (transient ischemic attack,
TIA) , [17]
(ischemic stroke,
ISC), (ICH),
(subarachnoid haemorrhage, SAH)
. [9] TIA, ICH, ISC, SAH ,
[12] ISC SAH ,
[18] ISC
.
, Bergman
[16] CI ICH , Taylor
[11] ISC, ICH, SAH , Persson [13] ISC ICH
. (WHO)
. . , , , , 12 [30]. [31] . . , 65 , , 65 60-64 . 65 , 0 , 65 . 5% 1 2005 , . , , . . , ( ), ( ) ( ) . . . , 1/3 . 1 1/3 [27]. 2005 , [29] . [3,25]. , 20-50 , 20-50 2005 (56,809 ) . 65 65 (56,809 ) . . 2005 , , . . [2,3,22] . ( ), , . , , . . . 2005 [28] . 24.5% , 15.8% , 32.5% 18.8% . 1 . , 2 . , 65 1 . 2005 .
. D = , HE= , NHE= s = (1= , 2= ), y = (20-24 , 25-29 , 30-34 , , 85 ) Esy= s , y OEsy= s , y = , = Bsy= s , y Nsy= s , y Msy= s , y Csy= s , y H = 65 , ,
(human capital approach) (the gross loss
output approach) [32]. ID = , PL = , IC = , PD = s = (1= , 2= ), y = (20-24 , 25-29 , 30-34 , , 85 ) Isy= s , y Nsy= s , y Lsy= s , y Tsy= s , y F = 20 50 Dsy= s , y P(n)sy= s , y W(n)s= s , n E(n)s= s , n = (5%) 1 2005 . , , 2005 2005 1 . TCC = 1 , A = 2005 HE = , NHE = , PL = , IC = 2005 20 36,183,977 [33] 882,143 2.4% . 90,550 , 469,914 10.3%, 53.3% Table 1. Treated prevalence rate of stroke, hemorrhagic stroke, and ischemic stroke by sex and age
groups, 2005
Age Stroke
no. % no. % no. %
Hemorrhagic stroke Ischemic stroke
Male Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Female Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Total 400,276 1,915 2,720 4,934 8,645 16,039 29,168 37,939 47,004 57,006 64,783 57,903 39,927 22,018 10,275 481,867 1,846 2,799 4,447 7,434 12,795 25,285 35,877 44,290 59,604 79,097 81,532 65,591 39,609 21,661 882,143 2.24 0.10 0.14 0.22 0.38 0.72 1.44 2.67 4.21 6.04 8.65 12.54 15.97 16.73 16.91 2.63 0.10 0.15 0.20 0.34 0.60 1.29 2.55 3.91 5.66 8.53 11.63 13.74 13.91 11.97 2.44 45,375 502 689 1,139 1,904 3,210 5,192 5,616 5,745 5,969 5,801 4,490 2,870 1,482 766 45,175 322 510 702 1,124 1,911 3,562 4,559 5,124 5,868 6,621 5,902 4,429 2,735 1,806 90,550 0.25 0.03 0.03 0.05 0.08 0.14 0.26 0.40 0.51 0.63 0.77 0.97 1.15 1.13 1.26 0.25 0.02 0.03 0.03 0.05 0.09 0.18 0.32 0.45 0.56 0.71 0.84 0.93 0.96 1.00 0.25 226,118 314 543 1,211 2,597 5,898 12,671 19,062 25,757 33,928 40,299 36,875 26,172 14,285 6,506 243,796 280 480 883 1,763 3,571 8,247 13,738 19,481 29,756 43,219 47,311 39,127 23,427 12,513 469,914 1.27 0.02 0.03 0.05 0.12 0.27 0.63 1.34 2.31 3.59 5.38 7.99 10.47 10.85 10.71 1.33 0.02 0.03 0.04 0.08 0.17 0.42 0.98 1.72 2.82 4.66 6.75 8.20 8.23 6.91 1.30
(Table 1). ( ) Table 2 3 7,370 2 2 . 1 1,301 5 7 (30.2%), 2 6,068 6 6 (69.8%) 2.3 . 99.3%(1 1,218 3 6 ) , 0.7%(83 2 1 ) . 1 3,643 1 8 , 6,167 7 , 6,258 4 1 (52.3%), (24.0%), (23.7%) . 36.5% (30.0%), (16.8%), (16.5%), (0.2%) . 61.8% (2 3,076 4 4 ), 38.2%(1 4,293 7 8 ) 1.6 . 45-49 (12.4%), 50-54 (11.2%), 40-44 (9.4%) . , 75-79 (14.9%), 70-74 (14.4%), 65-69 (11.4%) . ( ) Table 3 1 3,239 9 1 35.4% . 3,601 4 2 (27.2%), 9,638 4 9 (72.8%) 2.7 . 99.8% (3,594 1 1 ) , 0.2% (7 3 ) . 6,996 1 6 , 1,327 9 1 , 1,314 4 2 (72.6%), (13.7%), (13.6%) . 52.8% (27.2%), (10.0%), (9.9%), (0.06%) . 68.1% (9,018 ), 31.9% (4,221 9 1 ) 2.1 . . , 45-49 (19.8%), 40-44 (17.1%), 50-54 (13.6%) , 70-74 (11.2%), 65-69 (10.7%), 45-49 (10.4%) . ( ) Table 4 1 5,533 2 6 41.6% . 5,699 1 6 (36.7%), 9,834 1 (63.3%) 1.7 . 99.2%(5,654 7 7 ) 0.8%(44 3 9 ) . 3,130 8 7 , 3,323 2 8 , 3,379 9 4 (34.4%), (33.8%), (31.8%), . 36.4% (21.7%), (21.4%), (20.2%), (0.3%) . 57.3% (8,905 6 4 ), 42.7% (6,627 6 2 ) . Table 2. The national total costs of stroke by sex and age groups, 2005
Age Direct costs (1) Healthcare costs Non-healthcare costs Productivity loss costs Informal care costs Premature death costs Indirect costs (2) Total costs (1)+(2) Male Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Female Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Total
Unit: 1,000,000 Korean won 535,768 2,265 3,015 4,762 12,889 25,583 43,747 52,425 59,645 70,633 78,537 73,208 57,234 33,587 18,237 586,068 1,371 2,651 4,187 7,112 12,236 26,887 34,296 43,464 60,366 86,803 102,050 97,359 66,355 40,929 1,121,836 4,299 6 12 33 53 113 244 374 398 384 882 652 505 497 144 4,022 6 13 17 24 53 116 162 253 295 716 889 624 474 378 8,321 408,959 344 1,202 4,234 11,245 25,497 46,826 54,321 48,176 36,622 25,146 23,924 19,337 11,593 6,219 207,748 258 823 1,255 2,106 4,414 8,717 10,047 9,528 10,040 7,640 9,663 9,887 7,134 4,476 616,707 284,646 701 995 2,148 4,707 9,999 18,092 27,388 32,517 38,296 43,690 41,568 33,597 20,142 10,806 341,195 380 778 1,329 2,226 4,579 9,490 16,846 21,441 32,008 49,642 62,791 64,244 46,354 29,087 625,841 1,073,972 4,666 14,205 36,094 81,111 155,095 177,040 122,802 85,319 49,648 73,052 84,476 81,571 66,948 41,944 290,346 4,286 3,927 5,176 14,880 19,989 26,156 20,172 17,156 9,672 17,973 29,779 42,158 41,252 37,770 1,364,318 2,307,644 7,984 19,430 47,271 110,005 216,288 285,949 257,310 226,055 195,583 221,307 223,829 192,243 132,766 77,351 1,429,378 6,302 8,192 11,964 26,349 41,271 71,366 81,523 91,842 112,381 162,773 205,173 214,273 161,569 112,640 3,737,022
. , 70-74 (12.9%), 65-69 (12.6%), 75-79 (11.4%) 75-79 (17.8%), 70-74 (16.4%), 80-84 (13.8%) . Table 5 , 1 , , . 1 , 1 , 1 . , 1 , . 1 51.2 , 6.8 , 59.7 , 6.4 , 47.1 , 6.7 . 1 3 . 1 2,685,559 , 6,847,128 , 2,632,593 . , , 1 , 40 60 (Figure 1). 20 . , 2005 20 36,183,977 [33] 882,143 2.4% . 3 7,370 2005 2.2%, 3.9% .
Table 3. The national total costs of hemorrhagic stroke by sex and age groups, 2005
Age Direct costs (1) Healthcare costs Non-healthcare costs Productivity loss costs Informal care costs Premature death costs Indirect costs (2) Total costs (1)+(2) Male Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Female Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Total
Unit: 1,000,000 Korean won 174,538 1,243 1,662 3,307 7,421 14,615 22,760 22,363 21,597 22,287 20,383 16,338 11,252 5,958 3,354 184,873 702 1,382 2,431 4,183 7,512 14,725 16,195 20,140 23,009 27,347 26,521 21,294 12,128 7,304 359,411 393 2 4 8 13 25 46 56 48 36 62 39 26 22 6 337 1 3 3 5 11 21 25 35 31 59 58 37 28 21 730 91,965 161 515 1,841 5,217 11,282 18,581 16,688 12,567 7,957 4,555 3,620 2,520 1,304 690 40,826 106 327 454 773 1,733 3,409 3,358 3,060 2,600 1,582 1,629 1,361 824 471 132,791 64,241 350 456 1,013 2,362 4,835 7,961 8,414 8,482 8,321 7,915 6,290 4,378 2,265 1,198 67,201 179 346 535 922 2,014 4,273 5,631 6,886 8,289 10,281 10,588 8,845 5,354 3,058 131,442 570,662 3,818 11,837 30,319 68,731 123,232 129,433 75,297 42,866 17,822 17,496 18,116 14,232 11,457 6,006 128,954 3,266 2,553 3,926 11,872 17,227 21,616 13,884 10,090 4,305 5,987 8,348 9,541 8,503 7,835 699,616 901,800 5,574 14,474 36,487 83,745 153,989 178,781 122,817 85,559 56,423 50,412 44,403 32,407 21,006 11,254 422,191 4,255 4,611 7,349 17,755 28,498 44,042 39,092 40,211 38,236 45,256 47,145 41,077 26,836 18,690 1,323,991
Figure 1. Per-capita costs of stroke, hemorrhagic stoke and ischemic stroke by sex and age groups 2005.
[34]. 30.2%, 69.8% . 15 (61.1%) (38.9%) [3]. 32.6-70.4% . . , . , . , . , [35]. 2001 Chung Ko [27] 1 8 2.1 . (computed tomography, CT) , Chung Ko , 1 . . 77.0% 1 3,239 (35.4%), 1 5,533 (41.6%) . 90,550 , 469,914 10.3% 53.3% 5 . 1999 Kang [36] 40% . , 15-20% [37]. 1 6,847,128 , 2,632,593 2.6 . . . , , . 52.8% , 36.4% . , , . Table 4. The national total costs of ischemic stroke by sex and age groups, 2005
Age Direct costs (1) Healthcare costs Non-healthcare costs Productivity loss costs Informal care costs Premature death costs Indirect costs (2) Total costs (1)+(2) Male Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Female Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Total
Unit: 1,000,000 Korean won 275,473 383 527 1,380 3,231 6,914 14,358 22,187 28,732 37,921 45,652 44,908 35,771 21,683 11,827 290,004 220 632 1,117 1,737 3,181 6,983 10,771 14,970 26,561 43,481 56,483 57,321 41,323 25,224 565,477 2,369 1 3 9 17 42 105 184 209 218 518 384 300 295 84 2,070 1 3 5 7 16 40 64 110 144 375 487 347 267 203 4,439 221,661 62 220 1,103 3,121 8,044 17,773 25,513 24,737 20,674 14,854 14,785 12,067 7,414 3,975 110,667 43 221 393 582 1,259 2,761 3,639 3,753 4,820 4,074 5,556 5,881 4,405 2,747 332,328 155,317 124 179 557 1,282 3,056 6,688 12,864 16,697 21,618 25,809 25,689 20,967 12,882 6,906 182,677 59 215 417 604 1,292 2,920 6,101 8,445 15,366 26,471 36,102 38,212 28,621 17,851 337,994 235,744 0 947 2,887 5,550 11,901 24,101 21,288 19,832 14,656 25,265 29,541 32,413 28,235 19,128 77,343 612 393 357 633 1,184 2,665 2,947 2,768 2,290 5,438 9,779 16,100 16,684 15,492 313,087 890,564 570 1,875 5,935 13,201 29,957 63,026 82,036 90,207 95,088 112,098 115,306 101,518 70,509 41,920 662,762 935 1,464 2,289 3,564 6,932 15,369 23,522 30,046 49,179 79,839 108,407 117,861 91,301 61,518 1,553,326
. , 40 -60 60 -70 . , . , , . , , ( , ), . [38], [39] . . , , . , , . Lee [40] 2001 7 2002 7 1 , , , . Lee [40] 2005 1 1 8 1,574 . , 1 5,533 2005 1 7,107 . , 1 3 . , (ICD-10 : I20-I25) (ICD-10 : C00-C97, D00-D09) 1 . , , . , . . Table 5. Health care utilization and costs per patient of stroke, hemorrhagic stoke and ischemic stroke
by sex and age groups, 2005
Age Stroke
LOS* NOV Costs
Hemorrhagic stroke
LOS* NOV Costs
Ischemic stroke
LOS* NOV Costs
Male Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Female Sub total 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 74 75 - 79 80 - 84 85+ Total 49.8 37.5 36.6 39.0 45.9 51.1 51.9 52.3 52.9 50.6 47.5 47.5 50.9 50.0 51.1 52.4 27.1 32.7 36.8 35.9 39.1 41.5 43.4 45.4 47.2 49.1 53.8 59.2 60.8 59.6 51.2 7.1 3.9 4.1 4.3 5.0 6.0 6.6 7.0 7.2 7.3 7.6 7.7 7.4 7.0 6.4 6.6 2.8 3.6 3.2 3.8 4.5 5.3 5.8 6.3 6.7 7.1 7.3 7.2 6.8 6.2 6.8 3,082,053 1,732,395 1,920,860 2,265,311 3,342,296 3,815,228 3,733,852 3,545,383 2,994,140 2,559,999 2,288,487 2,406,652 2,771,852 2,989,306 3,445,896 2,363,791 1,091,972 1,523,628 1,526,569 1,542,809 1,663,336 1,788,024 1,710,043 1,686,287 1,723,196 1,830,672 2,151,227 2,624,058 3,037,606 3,456,474 2,685,559 57.9 42.0 39.4 46.1 56.3 63.1 63.7 62.3 63.9 60.3 55.8 53.6 52.7 45.7 45.1 61.6 36.6 40.0 43.8 43.5 50.8 58.2 58.5 66.2 67.5 68.6 68.3 66.2 55.9 43.9 59.7 6.5 4.7 4.8 4.5 5.7 6.6 7.0 7.4 7.4 6.9 6.3 6.1 5.3 4.9 4.0 6.3 3.0 4.0 3.3 4.2 5.9 6.4 6.8 7.5 6.8 6.6 6.0 6.0 5.1 4.3 6.4 7,297,799 3,499,309 3,826,713 5,415,938 7,885,151 9,581,623 9,504,705 8,461,442 7,431,404 6,466,796 5,674,143 5,854,622 6,332,858 6,443,454 6,851,090 6,491,144 3,071,784 4,035,323 4,876,209 5,234,323 5,897,667 6,296,101 5,529,244 5,878,503 5,782,288 5,930,997 6,573,501 7,120,454 6,703,006 6,010,213 6,847,128 44.7 34.1 30.5 35.5 36.8 40.7 42.4 45.6 45.7 44.7 42.8 44.0 46.6 47.5 48.7 49.3 23.6 39.5 41.5 35.8 35.7 37.0 37.4 36.9 42.3 44.4 49.8 54.6 58.1 57.4 47.1 6.9 4.5 4.2 4.8 5.2 6.1 6.6 6.9 7.0 7.0 7.2 7.1 6.8 6.5 6.0 6.5 3.9 4.9 5.2 4.8 4.9 5.8 6.1 6.4 6.5 6.8 6.9 6.7 6.5 5.8 6.7 2,895,922 1,814,400 1,708,523 2,516,670 2,946,165 3,061,409 3,071,915 3,186,836 2,732,270 2,370,653 2,154,727 2,325,853 2,640,425 2,959,342 3,503,308 2,401,264 1,154,202 2,232,328 2,187,991 1,662,324 1,609,764 1,540,452 1,497,632 1,400,229 1,575,800 1,721,481 2,084,671 2,600,796 3,185,065 3,678,229 2,632,593 Unit: day, Korean won
* LOS: length of stay, total LOS was divided by the number of inpatients to determine per-patient LOS in that age group,
NOV: number of outpatient visit, total NOV was divided by the number of outpatients to determine per-patient NOV in that age group, Total costs were divided by the number of total treated patients to determine per-patient costs in that age group
. , 2005 . , , . , . 2005 97% 3% . . , 20-50 . , . 55,000 56,890 , . , 1 . .
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