Estimating the Cost-Effectiveness of Stroke Units in France Compared With Conventional Care

Abstract

Background and Purpose-The incidence of stroke in France is estimated at between 120 000 and 150 000 cases per year.This modeling study assessed the clinical and economic benefits of establishing specialized stroke units compared with conventional care. Methods-Data from the Dijon stroke registry were used to determine healthcare trajectories according to the degree of autonomy and organization of patient care. The relative risks of death or institutionalization or death or dependence after passage through a stroke unit were compared with conventional care. These risks were then inserted with the costing data into a Markov model to estimate the cost-effectiveness of stroke units. Results-Patients cared for in a stroke unit survive more trimesters without sequelae in the 5 years after hospitalization than those cared for conventionally (11.6 versus 8.28 trimesters). The mean cost per patient at 5 years was estimated at 30 983 € for conventional care and 34 638 € in a stroke unit. An incremental cost-effectiveness ratio for stroke units of 1359 € per year of life gained without disability was estimated. Conclusions-The cost-effectiveness ratio for stroke units is much lower than the threshold (53 400 €) of acceptability recognized by the international scientific community. This finding justifies organizational changes in the management of stroke patients and the establishment of stroke units in France.

Cost-Effectiveness of Stroke Unit Care Followed by Early Supported Discharge

“…10 -12 Existing studies suggest that SU care is more expensive than the alternatives and there is only one study on the cost-effectiveness of SUs, which suggests that such increased costs are justified by the improved outcomes and this results in favorable incremental cost-effectiveness ratios for SU care. 12 Despite the recorded benefits of SUs dealing with acute treatment, there is less conclusive information available on the effective management of discharge and follow-up after acute SU care. The Royal College of Physicians Stroke guidelines state that "Specialist stroke services should be available in the community as a part of an integrated system of care to facilitate early supported discharge."…”

Cost Avoidance Associated With Optimal Stroke Care in Canada

“…Over the five-year period, however, stroke unit care increased survival with only minor disability by 240 days, yielding an incremental cost-effectiveness ratio associated with stroke care of just €1,359 per year of life gained with only minor disability. 45 The following assumptions were made in modeling the effect of this element of optimal care:  The 20% reduction in death and dependency reflects patients that would instead be discharged home  A maximum of 80% of stroke patients would be treated in an organized stroke unit, given the likelihood that smaller hospitals may not be in a position to establish organized stroke units and that not all stroke patients would be transferred to a hospital with an organized stroke unit. The effect of this assumption will be tested via sensitivity analysis.…”

Editorial Comment—Organized Stroke Care

“…3 More recent studies have generated additional data supporting the efficacy and costeffectiveness of stroke units. 215,216 A recent study found that stroke patients cared for in a stroke unit with continuous cardiac telemetry monitoring were more likely to have significant cardiac arrhythmias detected compared with stroke unit patients who did not have such monitoring. 217 This observation is shared by many vascular neurologists.…”