Alternative strategies for stroke care: cost-effectiveness and cost-utility analyses from a prospective randomized controlled trial.
OBJECTIVE
Although stroke units reduce mortality and institutionalization, their comparative cost-effectiveness is unknown.


METHODS
Healthcare, social services, and informal care costs were compared for 447 acute stroke patients randomly assigned to stroke unit, stroke team, or domiciliary stroke care. Prospective and retrospective methods were used to identify resource use over 12 months after stroke onset. Cost-effectiveness and cost-utility analyses were undertaken.


RESULTS
Mean healthcare and social care costs over 12 months were 11 450 pounds sterling for stroke unit, 9527 pounds sterling for stroke team, and 6840 pounds sterling for domiciliary care. More than half the costs were for the initial episode of care. Institutionalization was a large proportion of follow-up costs. Inclusion of informal care increased costs considerably. When informal care was excluded, the incremental cost-effectiveness ratio per percentage point in deaths or institutionalizations avoided in the first year was 496 pounds sterling for the stroke unit over domiciliary care; incremental cost per quality-adjusted life year quality-adjusted life year gained was 64 097 pounds sterling between these 2 groups. The stroke team was dominated by domiciliary care.


CONCLUSIONS
Cost perspectives, especially those related to long-term and informal care, are important when stroke services are evaluated. Improved health outcomes in the stroke unit come at a higher cost.
Patel
Anita
A
Centre for the Economics of Mental Health, Health Services Research Department, David Goldberg Centre, Institute of Psychiatry, De Crespigny Park, London SE5 8AF UK. a.patel@iop.kcl.ac.uk
Knapp
Martin
M
Perez
Inigo
I
Evans
Andrew
A
Kalra
Lalit
L
D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006295:Health Resources / Q000706:statistics & numerical data; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D007326:Institutionalization / Q000191:economics; D007362:Intensive Care Units / Q000191:economics*; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team / Q000191:economics*; D011446:Prospective Studies; D019057:Quality-Adjusted Life Years; D012189:Retrospective Studies; D012947:Social Work / Q000191:economics; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation; D006113:United Kingdom