Rising numbers of strokes could present significant societal challenges

Anita Patel is an independent health economics consultant and Honorary Professor at Queen Mary University of London. Her work with colleagues from Queen Mary University of London and the London School of Economics & Political Science estimated the current and future costs of stroke in the United Kingdom to inform the prioritisation of stroke in policy and research. Findings are reported in two linked papers (Patel et al. 2019; King et al. 2020)

Even with improved prevention and treatment, each year the UK experiences around 100,000 new strokes and over a million people living with its wide-ranging physical and psychological consequences. We estimated the associated societal costs now and in the future, using latest available data.

The figures clearly indicate that the economic burden of stroke extends well beyond those who experience a stroke and health care services – towards unpaid carers and social care services – and that these combined impacts will present real societal challenges in future. To alleviate potentially vast future care and cost burdens there is an urgent need for changes to how stroke is managed long term and how it is prioritised in policy and research. We need to further extend the delivery of cost-effective treatments and care, and invest across the whole stroke pathway from prevention through to treatment, rehabilitation and long-term care.

In summary, we estimated average annual costs per person for individuals aged ≥40 and extrapolated these to the UK using relevant stroke incidence and prevalence rates. We built upon modelling work by Xiang-Ming et al (2017) based on routine registry and audit data on health and social care. We segmented data for incident versus prevalent stroke, added unpaid care and lost productivity estimates (from research trials) and projected costs for the future using a new simulation model. This combined data on population projections (by the Office for National Statistics), future trends in incidence and prevalence (derived through a consultation with experts) and expected future changes in productivity and average earnings (from the Office for Budget Responsibility). 

We estimated that the average societal cost of a new onset stroke was £45,000 in the first year & £25,000 in subsequent years, totalling £26 billion per year for the UK (2015 prices). Much of this arose from the value of unpaid care from family and friends (£15.8 billion). We estimate that NHS costs drop from 30% of total costs in the first year after stroke to 9% in subsequent years, while social care costs rise from 11% to 22%.

Prevalent stroke accounts for the majority of total costs given the much larger number of stroke survivors (950,200) compared to new stroke cases each year (117,600). Our projections suggest that by 2035, the number of stroke survivors over the age of 45 is expected to more than double (to 2.1 million) and total costs could treble to £75 billion. Key drivers for this include: (i) predictions that the number of older people will increase substantially, due partly to rising life expectancy and partly to the ‘baby boom’ cohorts reaching older age; (ii) our assumption that because care is highly labour intensive, the cost per hour of care will rise in line with average earnings; and (iii) the experts we consulted anticipated stroke survival rates to improve. Our projected increase is highest for social care because of high use of social care in late older age by survivors of severe strokes. Although generating such estimates carries limitations and uncertainties, the total burden remained high even under more conservative assumptions.

Read the Age and Ageing paper Estimated societal costs of stroke in the UK based on a discrete event simulation

References

King D, Wittenberg R, Patel A, Quayyum Z, Berdunov V, Knapp M. The future incidence, prevalence and costs of stroke in the UK. Age and Ageing 2020; 1-–6.

Patel A, Berdunov V, Quayyum Z, King D, Knapp M, Wittenberg R. Estimated societal costs of stroke in the UK based on a discrete event simulation. Age and Ageing 2019; 1-7.

Xu XM, Vestesson E, Paley L, et al. The economic burden of stroke care in England, Wales and Northern Ireland: Using a national stroke register to estimate and report patient-level health economic outcomes in stroke. Eur Stroke J 2018; 3: 82-91.