National Institute for Stroke and Applied Neurosciences, School of Rehabilitation and Occupational Studies, School of Public Health and Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand.
Int J Stroke. 2012 Dec;7(8):623-30. doi: 10.1111/j.1747-4949.2011.00632.x. Epub 2011 Oct 20.
Acute stroke units in hospitals are known to be more costly than standard care, but proponents claim that the health gains will justify the expense. Yet, despite widespread adoption of stroke units, the evidence on the cost effectiveness of stroke units has been mixed, due in part to differences in the pathway of care across hospitals. The purpose of this study is to compare costs and outcomes for patients admitted to a stroke unit with those admitted to a general ward.
Data on 530 stroke sufferers from a large incidence study of stroke (the Auckland Regional Community Stroke Outcome Study) were used. Cost of health services, places of discharge were identified at one-, six- and 12 months poststroke and were linked with long-term cost and survival five-years poststroke. A decision analytical model was developed, including the relationship between waiting time for discharge and probability of admission to stroke unit. Cost effectiveness was determined using a willingness to pay threshold of NZ$20 000 (US$15 234).
Regression analysis suggested that there were no significant differences between patients admitted to a stroke unit and a general ward. The incremental cost-utility ratio for the first-year was NZ$42 813/quality-adjusted life year (US$32 610/quality-adjusted life year), but fell substantially to NZ$6747/quality-adjusted life year (US$5139/quality-adjusted life year) when lifetime costs and outcomes were considered. Probabilistic and one-way sensitivity analysis suggests that the results are robust to areas of uncertainty or delays in the pathway of care.
Stroke unit care was cost effective in Auckland, New Zealand.
医院中的急性脑卒中单元比标准护理费用更高，但支持者声称健康收益将证明这种费用是合理的。然而，尽管脑卒中单元已被广泛采用，但由于医院间护理路径的差异，脑卒中单元的成本效益证据一直存在分歧。本研究旨在比较入住脑卒中单元和普通病房的患者的成本和结局。
使用来自大型脑卒中发病研究（奥克兰地区社区脑卒中结局研究）的 530 名脑卒中患者的数据。在脑卒中发生后 1、6 和 12 个月，确定卫生服务成本和出院地点，并将其与脑卒中发生后 5 年的长期成本和生存情况相关联。开发了一个决策分析模型，包括出院等待时间与入住脑卒中单元概率之间的关系。使用 20000 新西兰元（15234 美元）的支付意愿阈值来确定成本效益。
回归分析表明，入住脑卒中单元和普通病房的患者之间没有显著差异。第一年的增量成本-效果比为 42813 新西兰元/质量调整生命年（32610 美元/质量调整生命年），但当考虑终生成本和结局时，该比值大幅降至 6747 新西兰元/质量调整生命年（5139 美元/质量调整生命年）。概率和单向敏感性分析表明，结果对护理路径中的不确定或延迟区域具有稳健性。
在新西兰奥克兰，脑卒中单元护理具有成本效益。
