Stroke case fatality is decreasing over time. Less,

however, is known about patients’ health-related quality of life

(HRQoL), quality-adjusted life years (QALYs), and costs. We studied

all these with two data sets collected in Finland 10 years apart.

Methods –

A total of 468 and 355 first-ever ischemic stroke patients

were followed up 1 year in two studies (Study 1 in 1989

–1991 and

Study 2 in 2001

–2003). Case fatality, HRQoL measured by the 15D,

QALYs, costs, and first-year cost/QALY were compared. Regression

analysis was used to examine the effects of various factors on QALYs.

Results –

In the later study, the case fatality rates were lower and the

mean 15D scores higher. During the follow-up year, patients

experienced on average 0.519 (95% CI 0.453

–0.555) and 0.646 (95%

CI 0.613

–0.680) QALYs in Study 1 and Study 2, respectively

(

P < 0.001). Age, modified Rankin Scale before stroke onset, acute

phase Scandinavian Stroke Scale, and the study group explained the

variance of QALYs. The first-year mean total costs were 10 626

€ and

14 603

€ and the mean cost/QALY 20 474 € and 22 605 € in Study 1

and Study 2, respectively. The incremental cost-effectiveness ratio of

Study 2 compared with Study 1 was 31 315

€ without and 60 684 €

with patient characteristics standardization.

Conclusions – Stroke

patients’ improved outcome is clear, but it remains uncertain to what

extent it is attributable to the development of care. More research is

needed to study the cost-effectiveness of stroke care.