Costs and quality adjusted life years at 12 months after stroke by urban and non-urban areas: Regions care economic evaluation.

Background and Aims: Initiatives at non-urban hospitals in New Zealand have improved access to reperfusion therapies for patients with stroke.We aimed to investigate if any additional costs are offset by improved outcomes and costs savings after discharge. Method(s): REGIONS Care involved consecutive patients admitted with stroke to all 28 acute stroke hospitals in New Zealand (12 urban) between May and October 2018. Costs from a societal perspective at 12 months after stroke were estimated using standardised data collected on the hospital stay and a follow-up survey. Estimated costs were assigned to the initial hospital patients presented to. Quality adjusted life years (QALYs) were estimated using outcomes at discharge from hospital, vital status and responses to the EuroQol-5D questionnaire at 12 months follow-up. Multiple imputation and multivariable regression analyses were used to assess differences between groups. Result(s): There were 946 patients from non-urban and 1419 from urban hospitals. Costs of acute care for patients presenting to urban hospitals were $1786 greater on average than those presenting to nonurban hospitals (p<0.001). Estimated costs until 12 months were no different between groups (urban $26137 vs non-urban $25067, p=0.396). The average QALYs per person was greater in the urban cohort than the non-urban cohort (0.58 vs 0.53, p=0.001). Conclusion(s): Despite greater costs of acute care, patients who presented to urban hospitals had similar costs at 12 months compared to non-urban counterparts. Further research is required to investigate if additional funding to non-urban hospitals can reduce downstream costs and improve outcomes.