Cost-effectiveness of integrated stroke services.
BACKGROUND
Randomized trials have shown that integrating services for acute stroke care may lead to organizational improvements, higher efficiency and better patient outcomes in the acute phase.


OBJECTIVE
To compare the costs and effects of stroke services in an experimental group of patients compared to a group of patients receiving conventional care.


METHODS
Prospective non-randomized controlled trial.


METHODS
We compared all consecutively hospitalized stroke patients in three experimental stroke service settings (Delft, Haarlem and Nijmegen, n = 411) with concurrent patients receiving conventional stroke care (n = 187) over 6 months follow-up. Main end-points were total costs per patient and total health-adjusted days per 100 patients as measured by the EuroQol-5D score during follow-up.


RESULTS
Mean total costs per patient were 16,000 Euro (95%CI 14,670 Euro-16,930 Euro): 13,160 Euro in Delft, 16,790 Euro in Haarlem, 20,230 Euro in Nijmegen, and 13,810 Euro in the control regions. Early discharge in Delft saved about 2500 Euro hospital costs per patient. General patient health in Delft was significantly better than in the control regions; Haarlem and Nijmegen showed no difference in health.


CONCLUSIONS
Our study confirms the potential to improve stroke outcomes in a cost-effective way in Dutch settings. This was seen in the group of patients in Delft, a complete and relatively simple stroke service, but not in two other regions with more complex stroke services. Important factors are reduction of hospital days and, most likely, adequate multidisciplinary rehabilitation.
van Exel
N J A
NJ
Institute for Medical Technology Assessment (iMTA), Erasmus MC, Rotterdam, The Netherlands. n.vanexel@erasmusmc.nl
Koopmanschap
M A
MA
Scholte op Reimer
W
W
Niessen
L W
LW
Huijsman
R
R
D000208:Acute Disease; D000368:Aged; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D009426:Netherlands; D011446:Prospective Studies; D020521:Stroke / Q000191:economics*; D000071939:Stroke Rehabilitation