A comparison of the cost-effectiveness of stroke care provided in London and Copenhagen.
OBJECTIVE
This study compared the relative cost-effectiveness of stroke care provided in London and Copenhagen.


METHODS
Hospitalized stroke patients at centers in London (1995-96) and Copenhagen (1994-95) were included. Each patient's use of hospital and community health services was recorded for 1 year after stroke. Center-specific unit costs were collected and converted into dollars using the Purchasing Power Parity Index. An incremental cost-effectiveness ratio (ICER) was calculated comparing a Copenhagen model of stroke care to a London model, using regression analysis to adjust for case-mix differences.


RESULTS
A total of 625 patients (297 in Copenhagen, 328 in London) were included in the analysis. Most patients in London (85%) were admitted to general medical wards, with 26% subsequently transferred to a stroke unit. In Copenhagen, 57% of patients were directly admitted to a stroke or neurology unit, with 23% then transferred to a separate rehabilitation hospital. The average length of total hospital stay was 11 days longer in Copenhagen. Patients in Copenhagen were less likely to die than those in London; for patients with cerebral infarction the hazard ratio after case-mix adjustment was 0.53 (95% CI from 0.35 to 0.80). However, a lower proportion of patients with hemorrhagic stroke died in London. The ICER of using the Copenhagen compared with the London model of care ranged from $21,579 to $37,444 per life-year gained for patients with cerebral infarctions.


CONCLUSIONS
The ICERs of the Copenhagen compared with the London model of care were within a range generally regarded as cost-effective.
Guy's, King's, and St. Thomas' School of Medicine.
R
R
Grieve
V
V
Porsdal
J
J
Hutton
C
C
Wolfe
D000368:Aged; D003153:Community Health Services / Q000191:economics / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D003431:Cross-Cultural Comparison; D003718:Denmark; D003954:Diagnostic Services / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006757:Hospital Units / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008131:London; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D012044:Regression Analysis; D012047:Rehabilitation Centers / Q000191:economics / Q000706:statistics & numerical data; D020521:Stroke / Q000191:economics* / Q000628:therapy*; D026712:Value of Life