Objectives: This study compared the relative cost-effectiveness of stroke care provided inLondon and Copenhagen.

Methods: Hospitalized stroke patients at centers in London (1995–96)and Copenhagen (1994–95) were included. Each patient's use ofhospital and community health services was recorded for 1 year afterstroke. Center-specific unit costs were collected and converted intodollars using the Purchasing Power Parity Index. An incrementalcost-effectiveness ratio (ICER) was calculated comparing a Copenhagenmodel of stroke care to a London model, using regression analysis toadjust for case-mix differences.

Results: A total of 625 patients (297 in Copenhagen, 328 in London)were included in the analysis. Most patients in London (85%) wereadmitted to general medical wards,with 26% subsequently transferred to a stroke unit. In Copenhagen, 57% of patients weredirectly admitted to a stroke or neurology unit, with 23% then transferred toa separate rehabilitation hospital. The average length of totalhospital stay was 11 days longer in Copenhagen. Patients inCopenhagen were less likely to die than those in London; for patientswith cerebral infarction the hazard ratio after case-mix adjustmentwas 0.53 (95% CI from 0.35 to 0.80). However, a lower proportion ofpatients with hemorrhagic stroke died in London. The ICER of usingthe Copenhagen compared with the London model of care ranged from $21,579 to $37,444 per life-year gained for patients with cerebralinfarctions.

Conclusions: The ICERs of the Copenhagen compared with the London modelof care were within a range generally regarded as cost-effective.