QJM Advance Access originally published online on May 6, 2005
QJM 2005 98(6):415-425; doi:10.1093/qjmed/hci065
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Cost-effectiveness of integrated stroke services
From the 1Institute for Medical Technology Assessment (iMTA), 2Department of Health Policy and Management (iBMG), and 3Department of Cardiology, Clinical Epidemiology & Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
Address correspondence to Dr N.J.A. van Exel, Erasmus MC, Institute for Medical Technology Assessment (iMTA), Office WL4-121, PO Box 1738, 3000 DR Rotterdam, The Netherlands. e-mail: n.vanexel{at}erasmusmc.nl
Received 24 August 2004 and in revised form 12 January 2005
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.
Aim: To compare the costs and effects of stroke services in an experimental group of patients compared to a group of patients receiving conventional care.
Design: 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 (95%CI 14 670–16 930): 13 160 in Delft, 16 790 in Haarlem, 20 230 in Nijmegen, and 13 810 in the control regions. Early discharge in Delft saved about 2500 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.
Discussion: 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.
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