Estimating the economic burden of ischaemic stroke in China from 2022 to 2030: a population-based modelling study

Objective To forecast the 2022–2030 disease and economic burden of ischaemic stroke (IS) in China; to assess the sensitivity of the projected IS-related economic burden to key inputs and to propose recommendations for IS prevention and control. Methods Data from multiple sources were integrated to estimate the economic burden of IS in China using a bottom-up cost-of-illness approach and the human capital method. Data on direct medical costs, direct non-medical costs (including informal care, accommodation and transportation) and indirect costs were collected for 2009–2021. The Chinese population was considered the overall study population, with age-specific population groups, including individuals aged ≥60 years, used for the stratified estimation of indirect costs. Candidate autoregressive integrated moving average (ARIMA) models were evaluated using a grid-search procedure over prespecified combinations of the autoregressive order, differencing order and moving-average order. The optimal ARIMA model was selected based on the overall balance of Akaike information criterion, Bayesian information criterion, forecasting performance, model parsimony and residual diagnostics. The selected model was then fitted to the observed data from 2009 to 2021 to forecast the economic burden of IS in China from 2022 to 2030. Results The projected number of IS cases in China was forecast to increase from 22 million (95% prediction interval (PI) 21.8 to 22.3 million) in 2022 to 32.9 million (95% PI 29.1 to 36.8 million) in 2030. Over the same period, per case indirect costs are forecast to increase from RMB 44 540.62 (95% PI 36 931.69 to 52 149.56) to RMB 54 692.95 (95% PI 31 866.13 to 77 519.77), while per case direct costs are projected to increase from RMB 19 156.09 (95% PI 18 306.12 to 20 006.06) to RMB 23 236.10 (95% PI 20 686.20 to 25 786.00). Indirect costs remained the predominant component of the economic burden, accounting for approximately 70% of the total annual per case cost throughout the projection period. The total annual per case cost is projected to increase from RMB 63 696.71 in 2022 to RMB 77 929.05 in 2030. By 2030, the total annual economic burden is projected to exceed RMB 2567 billion. Sensitivity analyses showed that variations in indirect cost per case had the greatest influence on the projected total economic burden, while changes in direct cost per case had a relatively limited effect. Conclusions The economic burden of IS in China is projected to increase substantially by 2030, with indirect costs remaining the predominant component. These findings underscore the need for population-wide prevention and screening, particularly among older adults and individuals with major vascular risk factors, as well as improved access to acute treatment, individualised rehabilitation, long-term care and home-based support. Local policymakers should consider regional population characteristics, healthcare capacity and rehabilitation needs when allocating health resources. Expanding insurance coverage for rehabilitation and long-term care may help mitigate the substantial indirect economic consequences of IS.