Treatment of Patients with Acute Stroke in Stroke Units (with or without Early Supported Discharge)

Background Stroke is the third most common cause of death, a major cause of severe disability in Norway and accounts for considerable amounts of healthcare resources. The organization of treatment and rehabilitation of stroke patients may improve functional outcomes and enhance quality of life for individuals with acute stroke.

Task requirement Norwegian Directorate of Health’s development group for the preparation of national clinical guideline for stroke has commissioned Norwegian Knowledge Centre for the Health Services to conduct economic evaluations of some central recommendations in the stroke guideline. We evaluated the clinical efficacy and conducted health economic model analyses of stroke unit care compared with stroke unit care followed by early supported discharge or general medical ward care.

Main Results

• Ordinary stroke unit care is associated with probably lower mortality than care in general medical wards, whereas there is possibly little or no difference between the two strategies for moderate or severe sequelae.
• The results of the meta-analyses of comparison between two different stroke units (with and without early supported discharge) show possibly little or no difference in mortality and dependency with care in stroke unit with early supported discharge.
• The economic evaluation found that ordinary stroke unit care dominate the care in the general medical ward because it has lower expected cost and higher expected quality-adjusted life years.
• Stroke unit care followed by early supported discharge reduces lifetime costs and adds quality-adjusted life years compared with ordinary stroke unit care.
• The sensitivity analyses indicate that stroke unit care followed by early supported discharge most likely is the most cost-effective strategy.