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(Stroke. 2001;32:1684.)
© 2001 American Heart Association, Inc.

Original Contributions

A Comparison of the Costs and Survival of Hospital-Admitted Stroke Patients Across Europe

R. Grieve, MSc; J. Hutton, BPhil; A. Bhalla, MRCP; D. Rastenytë, PhD; D. Ryglewicz, PhD; C. Sarti, PhD; M. Lamassa, MD; M. Giroud, MD; R. Dundas, MSc; C.D.A. Wolfe, MD on behalf of the Biomed II European Study of Stroke Care

From the Department of Public Health Sciences, GKT School of Medicine, London, UK (R.G., J.H., A.B., R.D., C.D.A.W.); Institute of Cardiology, Medical Academy, Kaunas, Lithuania (D. Rastenytë); Institute of Psychiatry and Neurology, Warsaw, Poland (D. Ryglewicz); National Institute of Public Health, Helsinki, Finland (C.S.); Department of Neurology and Psychiatry, Careggi University, Florence, Italy (M.L.); and Department of Neurology, University Hospital, Dijon, France (M.G.).

Correspondence to Richard Grieve, Health Services Research Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. E-mail richard.grieve{at}lshtm.ac.uk

Background and Purpose—Policy makers require evidence on the costs and outcomes of different ways of organizing stroke care. This study compared the costs and survival of different ways of providing stroke care.

Methods—Hospitalized stroke patients from 13 European centers were included, with demographic, case-mix, and resource use variables measured for each patient. Unit costs were collected and converted into US dollars using the purchasing power parity (PPP) index. Cox and linear regression analyses were used to compare survival and costs between the centers adjusting for case mix.

Results—A total of 1847 patients were included in the study. After case-mix adjustment, the mean predicted costs ranged from $466 [95% CI 181 to 751] in Riga (Latvia) to $8512 [7696 to 9328] in Copenhagen (Denmark), which reflected differences in unit costs, and resource use. The mean length of hospitalization ranged from 8.3 days in Menorca (Spain) to 36.8 days in Turku B (Finland). In the 3 Finnish centers at least 80% of patients were admitted to wards providing organized stroke care, which was not provided at the centers in Almada (Portugal), Menorca, or Riga. Patients in Turku A and Turku B were less likely to die than those in Riga, Warsaw (Poland), or Menorca. The adjusted hazard ratios were 0.18 [0.10 to 0.32] for Turku A, 0.18 [0.10 to 0.32] for Turku B, 0.68 [0.48 to 0.96] for Warsaw, and 0.56 [0.33 to 0.96] for Menorca, all compared with Riga.

Conclusions—The cost of stroke care varies across Europe because of differences in unit costs, and resource use. Further research is needed to assess which ways of organizing stroke care are the most cost-effective.

Key Words: costs and cost analysis • stroke management • survival

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