Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients - The Goteborg 70+ stroke study

Background and Purpose-The aim of the present study was to examine resource utilization during a 12-month period after acute stroke in elderly patient s randomized to care in an acute stroke unit integrated with a care continu um compared with conventional care in general medical wards. A secondary ai m was to describe costs related to the severity of stroke. Methods-Two hundred forty-nine consecutive patients aged greater than or eq ual to 70 years with acute stroke within 7 days before admission, living in their own homes in Goteborg, Sweden, without recognized need of care were randomized to 2 groups: 166 patients were assigned to nonintensive stroke u nit cafe with a care continuum, and 83 patients were assigned to convention al 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) (equi valent to $25 373) and 191 000 SEK ($28 507) in the stroke unit and the gen eral medical ward groups, respectively (P = NS). Seventy percent of the tot al cost was for inpatient care, and 30% was for outpatient and informal car e. For patients with mild, moderate, and severe stroke, the mean annual cos ts per patient were 107 000 SEK ($15 970), 263 000 SEK ($39 254), and 220 0 00 SEK ($32 836), respectively (P < 0.001). There was no statistical differ ence in age or nonstroke diagnosis. Conclusions-The total costs the first year did not differ significantly bet ween the treatment groups in this prospective study. The total annual cost per patient showed a very large variation, which was related to stroke seve rity at onset and not to age or nonstroke diagnoses. Costs other than those for hospital care constituted a substantial fraction of total costs and mu st be taken into account when organizing the management of stroke patients. The high variability in costs necessitates a larger study to assess long-t erm cost effectiveness.