Does warfarin-related intracerebral haemorrhage lead to higher costs of management?

• Warfarin use in intracerebral haemorrhage (ICH) leads to greater morbidity.
• Warfarin use in ICH leads to both higher rates of and earlier mortality.
• Warfarin use in survivors is associated with greater length of stay and cost.
• Increased costs of survivors are discounted by greater early mortality on warfarin.
• Warfarin use does not increase the overall cost of treatment in ICH.

Background and purposeWarfarin-related intracerebral haemorrhage is associated with significant morbidity but long term treatment costs are unknown. Our study aimed to assess the cost of warfarin-related intracerebral haemorrhage.MethodsWe included all patients with intracerebral haemorrhage between July 2006 and December 2011 at a single centre. We collected data on anticoagulant use, baseline clinical variables, discharge destinations, modified Rankin Scale at discharge and in-hospital costings. First year costings were extracted from previous studies. Multiple linear regression for treatment cost was performed with stratified analysis to assess for effect modification.ResultsThere were 694 intracerebral haemorrhage patients, with 108 (15.6%) previously on warfarin. Mean age (SD) of participants was 70.3 (13.6) and 58.5% were male. Patients on warfarin compared to those not on warfarin had significantly lower rates of discharge home (12.0% versus 18.9%, p = 0.013). Overall total costs between groups were similar, $AUD 25,767 for warfarin-related intracerebral haemorrhage and $AUD 27,388 for non-warfarin intracerebral haemorrhage (p = 0.353). Stratified analysis showed survivors of warfarin-related intracerebral haemorrhage had higher costs compared to those without warfarin ($AUD 33,419 versus $AUD 30,193, p < 0.001) as well as increased length of stay (12 days versus 8 days, p < 0.001). Inpatient mortality of patients on warfarin was associated with a shorter length of stay (p = 0.001) and lower costs.ConclusionSurvival of initial haemorrhage on warfarin was associated with increased treatment cost and length of stay but this was discounted by higher rates and earlier nature of mortality in warfarinised patients.