Estimating the cost-effectiveness of stroke units in France compared with conventional care

• Published in: Stroke (1970) Vol. 35; no. 3; pp. 770 - 775
• Main Authors: LAUNOIS, R, GIROUD, M, MEGNIGBETO, A. C, LE LAY, K, PRESENTE, G, MAHAGNE, M. H, DURAND, I, GAUDIN, A. F
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.2004
• Subjects: Biological and medical sciences; Cohort Studies; Cost-Benefit Analysis; France - epidemiology; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Hospital Costs - statistics & numerical data; Humans; Incidence; Intensive Care Units - economics; Intensive Care Units - utilization; Markov Chains; Medical sciences; Meta-Analysis as Topic; Models, Econometric; Nervous system (semeiology, syndromes); Neurology; Outcome and Process Assessment (Health Care) - statistics & numerical data; Patient Care - economics; Patient Care - methods; Randomized Controlled Trials as Topic - statistics & numerical data; Registries - statistics & numerical data; Sensitivity and Specificity; Stroke - economics; Stroke - epidemiology; Stroke - mortality; Stroke - therapy; Vascular diseases and vascular malformations of the nervous system; France; Europe; Nervous system diseases; Stroke; stroke units; Cardiovascular disease; Markov chains; Cost benefit analysis; Cerebral disorder; Vascular disease; economics; cost-benefit analysis; Central nervous system disease; Cerebrovascular disease; Cost efficiency analysis
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000117574.19517.80

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. 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. 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. 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.