Cost Utility Analysis of Multidisciplinary Postacute Care for Stroke: A Prospective Six-Hospital Cohort Study

Abstract

BackgroundFew studies have compared the optimal duration and intensity of organized multidisciplinary neurological/rehabilitative care delivered in a regional/district hospital with the standard rehabilitative care delivered in the general neurology/rehabilitation ward of a medical center. This study measured functional outcomes and conducted cost-utility analysis of an organized multidisciplinary postacute care (PAC) project in secondary care compared with standard rehabilitative care delivered in tertiary care.MethodsThis prospective cohort study enrolled 1,476 patients who had a stroke between March 2014 and March 2018 and had a modified Rankin scale score of 2–4. After exact matching for age ± 1 year, sex, year of stroke diagnosis, nasogastric tube, and Foley catheter and propensity score matching for the other covariates, we obtained 120 patients receiving PAC (the PAC group) from four regional/district hospitals and 120 patients not receiving PAC (the non-PAC group) from two medical centers.ResultsAt baseline, the non-PAC group showed significantly better functional outcomes than the PAC group, including EuroQol-5 dimensions (EQ-5D), Mini-Mental State Examination (MMSE) and Barthel index (BI). During weeks 7–12 of rehabilitation, improvements in all functional outcomes were significantly larger in the PAC group (P < 0.001) except for Functional Oral Intake Scale (FOIS). Cost-utility analysis revealed that the PAC group had a significantly lower mean (± standard deviation) of direct medical costs (US$3,480 ± $1,758 vs. US$3,785 ± $3,840, P < 0.001) and a significantly higher average gain of quality-adjusted life years (0.1993 vs. 0.1233, P < 0.001). The PAC project was an economically “dominant” strategy.ConclusionsThe PAC project saved costs and significantly improved the functional outcomes of patients with stroke with slight to moderately severe disabilities. Randomized control trials are required to corroborate these results.

The Impact of Post-Acute Care on Depression and Anxiety in Stroke Patients: A Prospective Study to Explore the Mediating Effect of Cognitive Function

“…It has been demonstrated that there was a significant improvement in cognitive function at week 12 in the PAC group compared to the non-PAC group (P<0.05), but there was no significant difference at year 1. 17 It also has noted significant improvements in cognitive function scores after a mean of 43.57 days of PAC participation, 18 which is consistent with the path significance in the current study. There was no correlation between PAC participation and cognitive function in the long term, but there was a more significant correlation in the short term.…”

“…The MMSE is an 11-question scale measuring time and place orientation, attention and computation, immediate and short-term memory, language, and visuospatial abilities. The maximum score is 30, with higher scores indicating better ability and scores below 25 indicating severe (≤9), moderate (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), or mild (21)(22)(23)(24) impairment, respectively. The Beck Depression Inventory (BDI) comprises 21 questions, each with four options, ranging from 0 (not at all) to 3 (severe).…”

Efficacy and Cost over 12 Hospitalization Weeks of Postacute Care for Stroke

“…The PAC-CVD program is considered a more economical and favorable recovery strategy than traditional rehabilitation [12,33]. Chen et al recently reported that within the first year after stroke rehabilitation, the NHI cost was higher in the non-PAC group (USD 3785 per person) than in the PAC group (USD 3480 per person) [13]. In the current study, the mean NHI cost during PAC-CVD hospitalization was USD 3189.95 (SD = USD 1501.07), and changes in the NHI cost varied depending on whether PAC-CVD hospitalization was extended.…”