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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.

P Pu ur rp po os se e: : In a pharmacoeconomic approach of anesthesia, postanesthesia care unit (PACU) occupancy can be chosen as a criteria of effectiveness to compare two anesthetic drugs with different rates of elimination and different costs of administration. Our objective was to develop a cost-effectiveness approach for the comparison of isoflurane (I) and desflurane (D). M Me et th ho od d: : In this prospective observational study, 68 patients aged 18-70 received either D or I for maintenance of anesthesia for inpatient abdominal procedures. Length of stay (LOS) in PACU was collected by a blinded observer. After the relationship between duration of surgery and LOS in PACU had been established in the 68 observed patients, we estimated the PACU occupancy according to duration of surgery and time of admission in PACU using a computer model of 204 consecutive patients, based on the hypothesis of an exclusive use of either D or I. Outcome measures were direct costs of the anesthesia procedure and occupancy of the PACU. R Re es su ul lt ts s: : The direct cost of the anesthetic was significantly higher with D than with I. This represents an increase of CAN$ 2 708 for the 204 patients. PACU occupancy was reduced by at least one patient (out of five beds) during 26.1% of the time with D (P <0.01). D Di is sc cu us ss si io on n: : Improving the throughput of patients in PACU by using new halogenated anesthetic agents with faster rates of elimination may outweigh the incremental cost of this strategy. This becomes particularly meaningful in operating theatres experiencing frequent overcrowded periods. Objectif : L'occupation de la salle de réveil (SDR) peut être choisie comme critère pour réaliser une étude coût-efficacité entre deux agents d'anesthésie de coûts d'administration différents. Le but du présent travail est de réaliser une comparaison coût-efficacité entre l'isoflurane (I) et le desflurane (D).