Stroke management cost: Review in Indonesia, Malaysia and Singapore

Stroke is one of the most common killers in Indonesia, Malaysia and Singapore. The mortality rate due to stroke in Indonesia is around 192/100.000, 84/100.000 and 47.9/100.000 for Malaysia and Singapore respectively in last 5 years. Treatment time, cost and quality are believed as main factors contributing to high mortality and disability caused by stroke. This paper presents the relation between stroke management cost, mortality rate and disability rate in Indonesia, Malaysia and Singapore. We used stroke epidemiological data in Indonesia, Malaysia and Singapore for last 12 years. This includes stroke prevalence, incidence, mortality and disability. Normalized clinical pathway for stroke management is used to define cost, quality and treatment duration. Administration, imaging, diagnosis, medication, intensive care, in ward recovery and outpatient rehabilitation are parts in stroke management system. We consider also country specific Gross Domestic Product (GDP per capita) and percentage of national health expenditure to justify the stroke management cost level. All related factors contributed directly and indirectly to the cost are connected through relationship trees model. The model has been simulated to produce normalized country specific cost, mortality-prevalence ratio, and disability-prevalence ratio. Simulation results show that normalized country specific costs for stroke management each one day care are 2.52% for Malaysia, 0.65% for Singapore and 3.88% for Indonesia. Based on this cost, Malaysia is able to have mortality-prevalence ratio and disability-prevalence ratio of 0.12 and 2.11 respectively. As country with highest GDP per capita, Singapore has successfully managed to have 0.01 and 0.22 mortality-prevalence ratio and disability-prevalence ratio respectively. Indonesia, however, with stroke management cost higher than Malaysia, is only able to suppress the mortality-prevalence ratio up to 0.16 and disability-prevalence ratio up to 2.80. This shows that stroke management system in Indonesia needs to be improved.