Purpose: Stroke is a major cause of mortality and severe disability and accounts for considerable amounts of healthcare resources. There is evidence that stroke units with or without early supported discharge (ESD) are effective in treating patients when compared with conventional care. However, their comparative cost-utility is unknown. The aim of this study was to assess the cost-utility of care in ordinary stroke units compared with the care provided in stroke units with ESD and general medical wards.
Method: Analyses were done in NorCaD, a Markov-model based on Norwegian incidence data and treatment costs. The model was run on 70-year-old men with average risk for further cardiovascular diseases. The patients were followed until death or 100 years of age. Effectiveness of the strategies was based on meta-analyses of published randomized controlled trials identified by a systematic search. Quality of life data were extracted from published literature. The model calculated quality-adjusted life year (QALY) gained with different strategies and life time costs related to stroke. We also analysed males at 50 years of age and females at both 50 and 70 years of age. In addition, we performed probabilistic sensitivity analyses to get an impression on uncertainty surrounding our analyses.
Result: Care in ordinary stroke units provided 0.33 additional QALYs and reduced lifetime costs for the health care system with NOK 338,000 (USD 56,000) compared with care in general medical wards. Hence, stroke units are dominant relative to general medical wards. Stroke units with ESD resulted in a QALY gain of 0.17 and reduced lifetime costs (NOK 127,000; USD 21,000) compared with ordinary stroke units, and hence ESD is a dominant strategy. Because ESD dominates ordinary stroke units, and ordinary stroke units dominate general medical wards, ESD also dominates general medical wards. Probabilistic sensitivity analyses documented little uncertainty regarding that stroke units with ESD are the most cost-effective strategy compared to ordinary stroke units and general medical wards. The results showed also little sensitivity with gender and age variation.
Conclusion: Ordinary stroke unit care is cost-effective relative to conventional care (general medical ward). Moreover, stroke units with ESD are cost-effective compared to ordinary stroke units.