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QJM Advance Access published online on May 6, 2005
QJM, doi:10.1093/qjmed/hci065
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© The Author 2005. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received August 24, 2004
Revised January 12, 2005

Original article

Cost-effectiveness of integrated stroke services

N.J.A. van Exel 1*, M.A. Koopmanschap 1, W. Scholte op Reimer 2, L.W. Niessen 1, and R. Huijsman 3

1 From the Institute for Medical Technology Assessment (iMTA), Rotterdam, The Netherlands; From the Department of Health Policy and Management (iBMG), Erasmus MC, Rotterdam, The Netherlands
2 From the Department of Cardiology, Clinical Epidemiology & Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands
3 From the Department of Health Policy and Management (iBMG), Erasmus MC, Rotterdam, The Netherlands

* To whom correspondence should be addressed.
N.J.A. van Exel, E-mail: n.vanexel{at}erasmusmc.nl


  Abstract

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 {euro}16 000 (95%CI {euro}14 670-{euro}16 930): {euro}13 160 in Delft, {euro}16 790 in Haarlem, {euro}20 230 in Nijmegen, and {euro}13 810 in the control regions. Early discharge in Delft saved about {euro}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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