Alternative Strategies for Stroke Care

Abstract

Background and Purpose— 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 for stroke unit, £9527 for stroke team, and £6840 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 for the stroke unit over domiciliary care; incremental cost per quality-adjusted life year quality-adjusted life year gained was £64 097 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.