The rising prevalence of stroke in an aging population is likely to more than double the cost of stroke care over the next two decades, the American Heart Association and American Stroke Association warned.
Annual stroke-related medical costs are projected to jump from $71.6 billion in 2012 to $183.1 billion in 2030, according to a statement from the organizations in the August issue of Stroke.
Total annual costs, including the price of lost productivity, were estimated to rise 129% to $240.67 billion by 2030, Bruce Ovbiagele, MD, MSc, of the Medical University of South Carolina in Charleston, and colleagues reported in the statement.
"It's a huge amount of money," commented Jennifer Frontera, a neurologist at the Cleveland Clinic. "$240 billion is actually equivalent to the GDP of a country like Israel or Singapore."
This toll needs to be firmly on the healthcare policy agenda at all levels and in all sectors, the statement urged.
"As we're moving forward we're going to have to plan better to try to address not only the burgeoning number of people that are having stroke but also the cost implications," co-author Larry B. Goldstein, MD, director of the Duke Stroke, added in an interview.
For physicians, that means taking what works in prevention and applying it more aggressively, said Ovbiagele, who also presented the findings at a briefing on President Obama's Brain Initiative on Capitol Hill.
"The biggest bang for buck would be primary prevention," he told MedPage Today in an interview. "We know it works but we know we have a lot of room for improvement. We could do more."
Up to 80% of strokes are preventable through control of hypertension, high cholesterol, diabetes, and obesity, he noted.
The Affordable Care Act provisions may help by boosting access to such care as well as rehabilitation for those who do have a stroke, he added.
Stroke-related care already accounts for about 11% of the Medicare budget and about 2% of total national health expenditure, even when excluding nursing home care for survivors.
The primary drivers for the projected increase were rising stroke rates and increasing per capita medical spending, according to the statement.
Stroke prevalence is expected to rise 21% by 2030, touching 4% of the American population compared with 3% in 2012, a difference of 3.4 million individuals.
Minorities will sustain the brunt of the projected shift, with a 29% relative increase among Hispanic men and a 26% to 27% increase among black men and women and those lumped into the "other" category, such as Asians and Native Americans.
The high prevalence among older adults, at around 15%, isn't expected to change much. But they are expected to be the biggest drivers of cost due to increasing numbers in this demographic.
The direct medical costs of stroke care may rise 182% among people ages 65 to 79 and 172% among those 80 and older.
"The aging of the population has a lesser impact on indirect than direct costs given the lower rates of employment among the elderly," Ovbiagele's group wrote.
Annual indirect costs for stroke were estimated to shoot up 68%, from $33.65 billion in 2012 to $56.54 billion in 2030.
Cost projections came from data in the National Health and Nutrition Examination Survey (NHANES), Census Bureau estimates for population counts out to 2030, and the Medical Expenditure Panel Survey.
Limitations included possible error in the surveys that went into the projections and an inability to account for future changes in medical treatment patterns or trends in obesity and diabetes.
UPDATE: This article, originally published May 22, 2013, at 12:00 p.m., was updated with new material at 1:15 p.m.
From the American Heart Association:
Primary source: Stroke: Journal of the American Heart Association
Source reference: Ovbiagele B, et al "Forecasting the future of stroke in the United States a policy statement from the American Heart Association and American Stroke Association" Stroke 2013;44.