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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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