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. 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 e16 000 (95%CI e14 670-e16 930): e13 160 in Delft, e16 790 in Haarlem, e20 230 in Nijmegen, and e13 810 in the control regions. Early discharge in Delft saved about e2500 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.