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Systematic review of economic evidence on stroke rehabilitation services

Published online by Cambridge University Press:  02 March 2005

Bruce K. Brady ,
Lynda McGahan  and
Becky Skidmore
Bruce K. Brady
Affiliation:
Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Lynda McGahan
Affiliation:
Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
Becky Skidmore
Affiliation:
Canadian Coordinating Office for Health Technology Assessment (CCOHTA)
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Abstract

Objectives: Given the resource-intensive nature of stroke rehabilitation, it is important that services be delivered in an evidence-based and cost-efficient manner. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of three rehabilitation services after stroke: stroke unit care versus care on another hospital ward, early supported discharge (ESD) services versus “usual care,” and community or home-based rehabilitation versus “usual care.”

Methods: A systematic literature review of cost analyses or economic evaluations was performed. Study characteristics and results (including mean total cost per patient) were summarized. The level of evidence concerning relative cost or cost-effectiveness for each service type was determined qualitatively.

Results: Fifteen studies met the inclusion criteria: three on stroke unit care, eight on ESD services, and four on community-based rehabilitation. All were classified as cost-consequences analysis or cost analysis. The time horizon was generally short (1 year or less). The comparators and the scope of costs varied between studies.

Conclusions: There was “some” evidence that the mean total cost per patient of rehabilitation in a stroke unit is comparable to care provided in another hospital ward. There is “moderate” evidence that ESD services provide care at modestly lower total costs than usual care for stroke patients with mild or moderate disability. There was “insufficient” evidence concerning the cost of community-based rehabilitation compared with usual care. Several methodological problems were encountered when analyzing the economic evidence.

Keywords

Cerebrovascular accidentRehabilitationEconomicsReviewMeta-analysis
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 1 , January 2005 , pp. 15 - 21
Copyright
© 2005 Cambridge University Press

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References

Guidelines for authors of CCOHTA health technology assessment reports. Rev. ed. 2003. Ottawa: Canadian Coordinating Office for Health Technology Assessment; Available: http://www.ccohta.ca/misc/authors_guidelines_files/AuthorsGuidelines.doc.
Anderson C, Mhurchu CN, Rubenach S, et al. 2000 Home or hospital for stroke rehabilitation? Results of a randomized controlled trial: II. Cost minimization analysis at 6 months. Stroke. 31: 1032– 1037.Google Scholar
Anderson C, Ni MC, Brown PM, Carter K. 2002 Stroke rehabilitation services to accelerate hospital discharge and provide home-based care: An overview and cost analysis. Pharmacoeconomics. 20: 537– 552.Google Scholar
Andersson A, Levin LÅ, Öberg B, Månsson L. 2002 Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke. Scand J Caring Sci. 16: 386– 392.Google Scholar
Beech R, Rudd AG, Tilling K, Wolfe CD. 1999 Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke. 30: 729– 735.Google Scholar
Claesson L, Gosman-Hedström G, Johannesson M, Fagerberg B, Blomstrand C. 2000 Resource utilization and costs of stroke unit care integrated in a care continuum: A 1-year controlled, prospective, randomized study in elderly patients: the Göteborg 70+ Stroke Study. Stroke. 31: 2569– 2577.Google Scholar
Gladman J, Whynes D, Lincoln N, DOMINO Study Group. 1994 Cost comparison of domiciliary and hospital-based stroke rehabilitation. Age Ageing. 23: 241– 245.Google Scholar
Hagenmeyer EG. 2000. Schlaganfallerkrankung, ökonomische Evaluation und Markov-Modell: Kosten-Nutzen-Vergleich von Normalstation- und Stroke-Unit-Behandlung im deutschen Gesundheitswesen [Gesundheit - Pflege - soziale Arbeit bd 7]. Lage (Deutschland): Hans Jacobs;
Hagenmeyer EG, Häussler B, Gothe H. 2002 Economic evaluation of stroke unit care versus traditional care in a German setting [poster]. 18th Annual Meeting of the International Society of Technology Assessment in Health Care; June 9–12; Berlin.
Holmqvist LW, De Pedro Cuesta J, Möller G, Holm M, Sidén Å. 1996 A pilot study of rehabilitation at home after stroke: A health-economic appraisal. Scand J Rehabil Med. 28: 9– 18.Google Scholar
Holmqvist LW, Von Koch L, Pedro-Cuesta J. 2000 Use of healthcare, impact on family caregivers and patient satisfaction of rehabilitation at home after stroke in southwest Stockholm. Scand J Rehabil Med. 32: 173– 179.Google Scholar
Hui E, Lum CM, Woo J, Or KH, Kay RL. 1995 Outcomes of elderly stroke patients. Day hospital versus conventional medical management. Stroke. 26: 1616– 1619.Google Scholar
Major K, Walker A. 1998: Economics of stroke unit care. In: Langhorne P, Martin D, eds. Stroke units: An evidence based approach. London: BMJ Books; 56– 65.
McNamee P, Christensen J, Soutter J, et al. 1998 Cost analysis of early supported hospital discharge for stroke. Age Ageing. 27: 345– 351.Google Scholar
Noorani HZ, Brady B, McGahan L, et al. 2003. Stroke rehabilitation services: systematic reviews of the clinical and economic evidence. Ottawa: Canadian Coordinating Office for Health Technology Assessment; Technology report no 35. Available at: http://www.ccohta.ca/publications/pdf/stroke_tr_e.pdf.
Roderick P, Low J, Day R, et al. 2001 Stroke rehabilitation after hospital discharge: A randomized trial comparing domiciliary and day-hospital care. Age Ageing. 30: 303– 310.Google Scholar
Teng J, Mayo NE, Latimer E, et al. 2003 Costs and caregiver consequences of early supported discharge for stroke patients. Stroke. 34: 528– 536.Google Scholar
Von Koch L, Pedro-Cuesta J, Kostulas V, Almazán J, Widén Holmqvist L. 2001 Randomized controlled trial of rehabilitation at home after stroke: one-year follow-up of patient outcome, resource use and cost. Cerebrovasc Dis. 12: 131– 138.Google Scholar
Warlow CP, van Gijn DJ, Hankey GJ, et al. 2001: The organization of stroke services. In: Stroke: A practical guide to management. 2nd ed. Malden, MA: Blackwell Science; 723– 761.
Young J, Forster A. 1993 Day hospital and home physiotherapy for stroke patients: A comparative cost-effectiveness study. J R Coll Physicians Lond. 27: 252– 258.Google Scholar