title: Health outcomes and costs of ischemic stroke patients in Finland.
abstract: OBJECTIVE
  Stroke case fatality is decreasing over time. Less, however, is known about patients' health-related quality of life (HRQoL), quality-adjusted life years (QALYs), and costs. We studied all these with two data sets collected in Finland 10 years apart.
  
  
  METHODS
  A total of 468 and 355 first-ever ischemic stroke patients were followed up 1 year in two studies (Study 1 in 1989-1991 and Study 2 in 2001-2003). Case fatality, HRQoL measured by the 15D, QALYs, costs, and first-year cost/QALY were compared. Regression analysis was used to examine the effects of various factors on QALYs.
  
  
  RESULTS
  In the later study, the case fatality rates were lower and the mean 15D scores higher. During the follow-up year, patients experienced on average 0.519 (95% CI 0.453-0.555) and 0.646 (95% CI 0.613-0.680) QALYs in Study 1 and Study 2, respectively (P < 0.001). Age, modified Rankin Scale before stroke onset, acute phase Scandinavian Stroke Scale, and the study group explained the variance of QALYs. The first-year mean total costs were 10 626 € and 14 603 € and the mean cost/QALY 20 474 € and 22 605 € in Study 1 and Study 2, respectively. The incremental cost-effectiveness ratio of Study 2 compared with Study 1 was 31 315 € without and 60 684 € with patient characteristics standardization.
  
  
  CONCLUSIONS
  Stroke patients' improved outcome is clear, but it remains uncertain to what extent it is attributable to the development of care. More research is needed to study the cost-effectiveness of stroke care.
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Puumalainen
authors.affiliation: Department of Neurosciences and Rehabilitation, Tampere University Hospital, Tampere, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Numminen
authors.affiliation: Network of Academic Health Centres and Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland.
authors.forename: O
authors.initials: O
authors.lastname: Elonheimo
authors.affiliation: Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland.
authors.forename: R O
authors.initials: RO
authors.lastname: Roine
authors.affiliation: Department of Public Health, University of Helsinki, Helsinki, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Sintonen
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D005387:Finland; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000191:economics*
keywords: case fatality; costs; health-related quality of life; quality-adjusted life years; stroke