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(Stroke. 2006;37:2790.)
© 2006 American Heart Association, Inc.

Original Contributions

Economic Evaluation of Australian Stroke Services

A Prospective, Multicenter Study Comparing Dedicated Stroke Units With Other Care Modalities

Marjory Moodie, DrPH; Dominique Cadilhac, MpubHlth; Dora Pearce, MIT; Cathrine Mihalopoulos, PGDHthEc; Robert Carter, PhD; Stephen Davis, MD; Geoffrey Donnan, MD for the SCOPES Study Group

From the Program Evaluation Unit (M.M., D.C., C.M., R.C.), School of Population Health, The University of Melbourne; the National Stroke Research Institute (D.C., D.P., G.D.), Austin Health, Heidelberg Heights; the National Stroke Foundation (D.C., S.D., G.D.), Melbourne; the Neurology Department (S.D.), Royal Melbourne Hospital, Parkville; the Neurology Department (G.D.), Austin Health, Heidelberg Heights; and the Department of Medicine (D.C., S.D., G.D.), The University of Melbourne.

Correspondence to Marjory L Moodie, Program Evaluation Unit, School of Public Health, 4/207 Bouverie Street, The University of Melbourne, Victoria 3010, Australia. E-mail mmoodie{at}unimelb.edu.au

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; $AUD12 251; $AUD15 903; $AUD15 383 respectively). This was primarily explained by the greater use of specialist medical services. The incremental cost-effectiveness of SCUs over conventional care was $AUD9867 per patient achieving thorough adherence to clinical processes and $AUD16 372 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.

Key Words: cost-effectiveness • stroke management • stroke units

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