Published Online
on December 18, 2003

A more recent version of this article appeared on January 1, 2004

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Submitted on September 1, 2003
Accepted on September 2, 2003

Alternative Strategies for Stroke Care. Cost-Effectiveness and Cost-Utility Analyses From a Prospective Randomized Controlled Trial

Anita Patel MSc^*; Martin Knapp PhD; Inigo Perez MD; Andrew Evans MRCP; and Lalit Kalra PhD

From the Centre for the Economics of Mental Health, Health Services Research Department, David Goldberg Centre, Institute of Psychiatry (A.P., M.K.); LSE Health and Social Care, London School of Economics and Political Science (M.K.); and Department of Medicine, Guy’s, King’s and St Thomas’ School of Medicine (I.P., A.E., L.K.), London, UK.

^* To whom correspondence should be addressed. E-mail: a.patel{at}iop.kcl.ac.uk.

Background and Purpose--Although stroke units reduce mortality and institutionalization, their comparative cost-effectiveness is unknown.

Methods-- Healthcare, social services, and informal care costs were compared for 447 acute stroke patients randomly assigned to stroke unit, stroke team, or domiciliary stroke care. Prospective and retrospective methods were used to identify resource use over 12 months after stroke onset. Cost-effectiveness and cost-utility analyses were undertaken.

Results--Mean healthcare and social care costs over 12 months were £11 450 for stroke unit, £9527 for stroke team, and £6840 for domiciliary care. More than half the costs were for the initial episode of care. Institutionalization was a large proportion of follow-up costs. Inclusion of informal care increased costs considerably. When informal care was excluded, the incremental cost-effectiveness ratio per percentage point in deaths or institutionalizations avoided in the first year was £496 for the stroke unit over domiciliary care; incremental cost per quality-adjusted life year quality-adjusted life year gained was £64 097 between these 2 groups. The stroke team was dominated by domiciliary care.

Conclusions--Cost perspectives, especially those related to long-term and informal care, are important when stroke services are evaluated. Improved health outcomes in the stroke unit come at a higher cost.

Key words: costs and cost analysis • randomized controlled trials • rehabilitation • stroke management

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