Economic evaluation of Australian stroke services: a prospective, multicenter study comparing dedicated stroke units with other care modalities.

BACKGROUND AND PURPOSE Level I evidence from randomized controlled trials demonstrates that the model of hospital care influences stroke outcomes; however, the economic evaluation of such is limited. An economic appraisal of 3 acute stroke care models was facilitated through the Stroke Care Outcomes: Providing Effective Services (SCOPES) study in Melbourne, Australia. The aim was to describe resource use up to 28 weeks poststroke for each model and examine the cost-effectiveness of stroke care units (SCUs). METHODS A prospective, multicenter, cohort study design was used. Costs and outcomes of stroke patients receiving 100% treatment in 1 of 3 inpatient care models (SCUs, mobile service, conventional care) were compared. Health-sector resource use up to 28 weeks was measured in 1999. Outcomes were thorough adherence to a suite of important clinical processes and the number of severe inpatient complications. RESULTS The sample comprised 395 participants (mean age 73 [SD 14], 77% first-ever strokes, males 53%). When compared with conventional care (n=84), costs for mobile service (n=209) were significantly higher (P=0.024), but borderline for SCU (n=102, P=0.08; 12,251 Australian dollars; 15,903 Australian dollars; 15,383 Australian dollars respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was 9867 Australian dollars per patient achieving thorough adherence to clinical processes and 16,372 Australian dollars per patient with severe complications avoided, based on costs to 28 weeks. CONCLUSIONS Although acute SCU costs are generally higher, they are more cost-effective than either mobile service or conventional care.