Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals - 09/05/24
, Helena Szrek d, Lara Noronha Ferreira e, f, g , Vitor Tedim Cruz b, h, João Firmino-Machado h, i, j
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Highlights |
• | First cost-effectiveness analysis of different stroke rehabilitation pathways. |
• | Inpatient unit followed by a community clinic was the most cost-effective pathway. |
• | Day hospital followed by a community clinic was also a cost-effective pathway. |
• | Cost-effectiveness analysis is consistent with stroke evidence-based practice. |
• | The incremental cost-effectiveness ratios are coherent between both perspectives. |
Abstract |
Background |
Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways.
Objective |
To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke.
Methods |
A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values.
Results |
From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual's perspective and between €10992 and €31319 from the healthcare service perspective.
Conclusion |
Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Pathway, Stroke, Rehabilitation, Outcomes, Cost-analysis, Health policy
Abbreviations : C, H, HB, ICER, MMSE, mRS, N, NHS, NIHSS, P, QALY, RC, UL, UM, US, WHO, WTP
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Vol 67 - N° 4
Articolo 101824- maggio 2024 Ritorno al numero
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