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Economic evaluation of Australian stroke services: a prospective, multicenter study comparing dedicated stroke units with other care modalities

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posted on 01.11.2006, 00:00 authored by Marj MoodieMarj Moodie, D Cadilhac, D Pearce, Cathy Mihalopoulos, Rob CarterRob Carter, S Davis, G Donnan
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.

History

Journal

Stroke

Volume

37

Issue

11

Pagination

2790 - 2795

Publisher

American Heart Association

Location

Dallas, Tex.

ISSN

0039-2499

eISSN

1524-4628

Language

eng

Publication classification

C1.1 Refereed article in a scholarly journal

Copyright notice

2006, American Heart Association, Inc