Cost-effectiveness of integrated stroke services

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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 €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.