Cost-effectiveness of a high-intensity rapid access outpatient stroke rehabilitation program

Abstract

A common strategy to improve cost-effectiveness in healthcare is to offer outpatient care instead of in-hospital care. Toronto Rehabilitation Institute developed an outpatient high-intensity fast-track (FT) stroke rehabilitation program aimed at discharging inpatient stroke rehabilitation patients earlier or bypassing inpatient rehabilitation altogether. This cost-effectiveness analysis compares FT rehabilitation within 1 week of discharge with no FT in a single healthcare payer system. Patient costs and outcomes over a 12-week time horizon were included. Using individual-level FT data from April 2015 to March 2016, incremental cost-effectiveness ratios (ICERs) (with 95% confidence interval) were estimated using regression. Subgroup analysis was completed for patients entering FT directly from inpatient rehabilitation and acute stroke care. Uncertainty was assessed using a cost-effectiveness acceptability curve with a range of willingness-to-pay values ($0–1000 per inpatient day saved). ICER (95% confidence interval) estimate for patients entering FT from inpatient rehabilitation was $404 ($270–620) per inpatient day saved. ICER estimate for direct from acute care admissions was $37 ($20–55) per day saved. At willingness-to-pay of $698 (cost of one alternate level of care day in acute care awaiting rehabilitation), the probability of FT being cost-effective was 99.2 and 100% for patients from inpatient rehabilitation and acute stroke care, respectively. From a single healthcare payer perspective, FT is a cost-effective method of providing appropriate rehabilitation intensity for stroke patients early on, and likely to provide savings to the healthcare system upstream through fewer days awaiting rehabilitation admission.

Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations

“…Multidisciplinary interventions included a range of interventions such as integrated rehabilitation services (n = 8), [29][30][31][32][33][34][35][36] extra rehabilitation care (n = 3), [37][38][39] rehabilitation team treatment, and fast-track specialized services (n = 6). [40][41][42][43][44][45] Fifteen studies were conducted in high-income countries (n = 1) in low-income country and (n = 1) in middle-income country. Thirteen studies focused on stroke on patients with TBI (n = 3) and ABI (n = 1).…”

“…A total of 3 studies [37][38][39] involving extra rehabilitation care reported cost savings ranging from £329 to £1889. A total of 4 studies [41][42][43][44] concluded that fast-track specialized services were cheaper and more cost-effective than usual care, with cost savings ranging from £253 to £6063 (costs converted to price year 2020 sterling prices). For instance, Grieve et al 41 found that "fast-track early" transfer to a neuroscience center was associated with lower mortality (odds ratio 0.52, 95% CI 0.34-0.80) and higher quality of life for survivors (mean gain 0.13, 95% CI 0.032-0.225) but positive incremental costs (£15 001, 95% CI £11 123-£18 880) compared with late or no transfer.…”

Application of Logistic Regression and Decision Tree Models in the Prediction of Activities of Daily Living in Patients with Stroke

“…However, early initiation of rehabilitation is limited by several barriers [25]. Tam et al [26] used a rapid access outpatient stroke rehabilitation program for providing rehabilitation. This approach could alleviate problems such as rehabilitation unavailability and the inability to treat patients in the hospital for a long period.…”

Physical Activity Behaviour in Solid Organ Transplant Recipients: Proposal of Theory-Driven Physical Activity Interventions

“…The balance between the cost of implementing physical activity and exercise-based rehabilitation programs versus the clinical and economic gains from e.g., lowered productivity losses and reduced need for hospitalizations and medication remains to be evaluated in transplant recipients. However, exercise-based rehabilitation has been shown to be cost-effective in many other chronic disease populations [123,124].…”