Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: the Czech Republic perspective

Abstract

The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4–69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.

Early rehabilitation after stroke in comprehensive cerebrovascular centres in the Czech Republic: a comparison of three stroke units

“…The average patient category in FNO amounted to 2. The study proved (Angerova et al, 2020) that the scores of the Barthel Index and the motor part of FIM are dependent on the categories, which is not true for the Extended Barthel Index or cognitive part of FIM. Generally, the measures based on motor skills are much more sensitive, while the cognitive results only had a small effect on the final state of patients.…”

“…The study was approved by the Ethics Committee of the General University Hospital in Prague on 15th December 2016. The detailed design of the study was published together with its first results (Angerova et al, 2020;2021). The study had a pragmatic design and the individual hospitals followed their standard clinical management procedures and processes.…”

“…The objective of this study was to calculate hospitalization costs in patients after stroke during the early rehabilitation therapy at stroke units. The main economic results have been recently published (Angerova et al, 2020;2021). The study was carried out in three backbone Czech hospitals in Prague, Ústí nad Labem and Ostrava.…”

Utilization of ADL performance tests to predict expected functional status in patients after stroke

“…Another important question was to what extent are BI and FIM interchangeable. This question was discussed in our previous article (Angerova et al, 2020). The tests, if properly conducted, proved a relatively good correlation in the motor component.…”

Cost analysis of early rehabilitation after stroke in comprehensive cerebrovascular centres in the Czech Republic

“…The differences can be found in all studied aspects of the early rehabilitation of patients after stroke, i.e., in costs, clinical outcomes, as well as in cost effectiveness ratios. This paper focused on the cost features; a study of outcomes and utilities was published elsewhere including a detailed discussion (30).…”