Out-of-pocket costs for childhood stroke: The impact of chronic illness on parents' pocketbooks

Patricia Plumb, Eric Seiber, Michael M. Dowling, Joellen Lee, Timothy J. Bernard, Gabrielle Deveber, Rebecca N. Ichord, Rachel Bastian, Warren D. Lo

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Objective Direct costs for children who had stroke are similar to those for adults. There is no information regarding the out-of-pocket costs families encounter. We described the out-of-pocket costs families encountered in the first year after a child's ischemic stroke. Methods Twenty-two subjects were prospectively recruited at four centers in the United States and Canada in 2008 and 2009 as part of the "Validation of the Pediatric NIH Stroke Scale" study; families' indirect costs were tracked for 1 year. Every 3 months, parents reported hours they did not work, nonreimbursed costs for medical visits or other health care, and mileage. They provided estimates of annual income. We calculated total out-of-pocket costs in US dollars and reported costs as a proportion of annual income. Results Total median out-of-pocket cost for the year after an ischemic stroke was $4354 (range, $0-$28,666; interquartile range, $1008-$8245). Out-of-pocket costs were greatest in the first 3 months after the incident stroke, with the largest proportion because of lost wages, followed by transportation, and nonreimbursed health care. For the entire year, median costs represented 6.8% (range, 0%-81.9%; interquartile range, 2.7%-17.2%) of annual income. Conclusions Out-of-pocket expenses are significant after a child's ischemic stroke. The median costs are noteworthy provided that the median American household had cash savings of $3650 at the time of the study. These results with previous reports of direct costs provide a more complete view of the overall costs to families and society. Childhood stroke creates an under-recognized cost to society because of decreased parental productivity.

Original languageEnglish (US)
Pages (from-to)73-76.e2
JournalPediatric Neurology
Issue number1
StatePublished - Jan 1 2015


  • childhood ischemic stroke
  • indirect cost
  • out-of-pocket cost
  • pediatric stroke

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Neurology
  • Developmental Neuroscience
  • Clinical Neurology


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