Estimated societal costs of stroke in the UK based on a discrete event simulation

Background: there are around 100,000 new stroke cases and over a million people living with its consequences annually in the UK. This has large impacts on health and social care, unpaid carers and lost productivity. We aimed to estimate associated costs. Methods: we estimated 2014/2015 annual mean cost per person and aggregate UK cost of stroke for individuals aged >= 40 from a societal perspective. Health and social care costs in the first and subsequent years after stroke were estimated from discrete event simulation modelling, with probability of progression and length of receipt of different health and social care services obtained from routine registry and audit data. Unpaid care hours and lost productivity were obtained from trial data. UK unit costs were applied to estimate mean costs. Epidemiological estimates of stroke incidence and prevalence were then applied to estimate aggregate costs for the UK. Results: mean cost of new-onset stroke is 45,409 (95% CI 42,054-48,763) in the first year after stroke and 24,778 pound (20,234-29,322) in subsequent years. Aggregate societal cost of stroke is 26 pound billion per year, including 8.6 pound billion for NHS and social care. The largest component of total cost was unpaid care (61%) and, given high survival, 20.6 pound billion related to ongoing care. Conclusion: the estimated aggregate cost of stroke substantially exceeds previous UK estimates. Since most of the cost is attributed to unpaid care, interventions aimed at rehabilitation and reducing new and recurrent stroke are likely to yield substantial benefits to carers and cost savings to society.