Resource Utilization and Costs of Stroke Unit Care Integrated in a Care Continuum: A 1-Year Controlled, Prospective, Randomized Study in Elderly Patients

Abstract

Background and Purpose-The aim of the present study was to examine resource utilization during a 12-month period after acute stroke in elderly patients randomized to care in an acute stroke unit integrated with a care continuum compared with conventional care in general medical wards. A secondary aim was to describe costs related to the severity of stroke. Methods-Two hundred forty-nine consecutive patients aged Ն70 years with acute stroke within 7 days before admission, living in their own homes in Göteborg, Sweden, without recognized need of care were randomized to 2 groups: 166 patients were assigned to nonintensive stroke unit care with a care continuum, and 83 patients were assigned to conventional care. There was no difference in mortality or the proportion of patients living at home after 1 year. Main outcomes were costs from inpatient care, outpatient care, and informal care. Results-Mean annual cost per patient was 170 000 Swedish crowns (SEK) (equivalent to $25 373) and 191 000 SEK ($28 507) in the stroke unit and the general medical ward groups, respectively (PϭNS). Seventy percent of the total cost was for inpatient care, and 30% was for outpatient and informal care. For patients with mild, moderate, and severe stroke, the mean annual costs per patient were 107 000 SEK ($15 970), 263 000 SEK ($39 254), and 220 000 SEK ($32 836), respectively (PϽ0.001). There was no statistical difference in age or nonstroke diagnosis. Conclusions-The total costs the first year did not differ significantly between the treatment groups in this prospective study. The total annual cost per patient showed a very large variation, which was related to stroke severity at onset and not to age or nonstroke diagnoses. Costs other than those for hospital care constituted a substantial fraction of total costs and must be taken into account when organizing the management of stroke patients. The high variability in costs necessitates a larger study to assess long-term cost effectiveness.

Cost Burden of Cardiovascular Hospitalization and Mortality in ATHENA‐Like Patients With Atrial Fibrillation/Atrial Flutter in the United States

“…For example, annual per-patient costs have been estimated at $14 000 for patients hospitalized with a primary diagnosis of AF, 26 $14 000 for patients hospitalized with CHF, 27 and $28 500 for patients with stroke (based on Swedish costs). 28 Costs of rehospitalization in particular are likely to have contributed to increased overall per-patient costs in our study, with 38.4% of all patients being readmitted over 12 months. This is broadly consistent with the high readmission rates observed previously among patients hospitalized for CV causes.…”

The cost-effectiveness of candesartan-based antihypertensive treatment for the prevention of nonfatal stroke: results from the Study on COgnition and Prognosis in the Elderly

“…The direct stroke-related cost during the first year after stroke was approximately 11 000 EUR in Zethraeus et al, 40 18 000 EUR in Claesson et al 41 and 17 000 EUR in Gatnekar et al 42 The difference is probably explained by the fact that the SCOPE population was selected based on a number of inclusion and exclusion criteria and thus healthier than an age-matched sample of the general population. This hypothesis is supported by the fact that the SCOPE population actually had a lower average mortality than the general Swedish population of the same age.…”

Financing intersectoral health promotion programmes: Some reasons why collaborators are collaborating as indicated by cost-effectiveness analyses

“…The time by voluntary workers was unfortunately valued differently in the two programmes: at the average Swedish wage excluding payroll taxes in the diabetes prevention programme and at 35% of the average Swedish wage in the safety promotion programme. The latter is a frequently used Swedish valuation of leisure time [13], which was also used for participants' time in both studies. Other resource consumption was taken from project accounts or quantified from standards (e.g.…”