Estimating the costs and benefits of stroke rehabilitation in South Africa

Abstract

ObjectiveThis paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation.DesignWe report an economic modelling approach using a worked cost‐effectiveness to validate the argument for the cost‐saving benefits of stroke rehabilitation.SettingSouth African health care, employing analysis of available secondary data from South African research and government reports.ParticipantsIn line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return‐to‐work as the desired rehabilitation outcome.InterventionsNot applicable.Main outcome measure(s)We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return‐to‐work rates, intervention costs, and the cost of rehabilitation services to estimate cost‐savings as a result of an individualized workplace intervention.ResultsThe cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return‐to‐work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%).ConclusionThe value of rehabilitation should not be considered in terms of cost‐effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.

Development of the Rehabilitation Health Policy, Systems, and Services Research Field: Quantitative Analyses of Publications over Time (1990–2017) and across Country Type

“…The growth over time has been significant and relatively linear, i.e., constant, over the 28-year period; nonetheless, rehabilitation represents a very small portion of all HPSSR. This may be concerning given the current high levels of physical rehabilitation needs worldwide (e.g., in 2017, 40% of the world's non-fatal health loss came from conditions amenable to physical rehabilitation [1]), the significant growth in those needs observed across country and condition types [1,61], the evidence for large gaps in the physical rehabilitation supply [6,29], and the growing evidence on the individual, economic, and broader societal benefits associated to the delivery of appropriate physical rehabilitation services [2,[62][63][64][65]. In other words, we have found that the amount of Rehabilitation HPSSR is a disproportionate to the global population's needs for such services.…”

Achieving universal health coverage for people with stroke in South Africa: protocol for a scoping review

“…4 Louw et al further affirm that 'improving capacity across African healthcare settings is essential to ensure best practice health programmes to increase awareness of stroke and its causes, its early identification and acute management, and its rehabilitation'. 36 In general, stroke care services in Africa are not adequately supported by governments, with limited support for either the development or implementation of national stroke policy frameworks, or limited provision and endorsement of evidence-based clinical practice guidelines. 37 Where policy frameworks or practice guidelines are available, the implementation processes may not be well supported by states, 38 which further limits best practice care for people with stroke.…”

“… 4 Louw et al further affirm that ‘improving capacity across African healthcare settings is essential to ensure best practice health programmes to increase awareness of stroke and its causes, its early identification and acute management, and its rehabilitation’. 36 …”

Examining the Availability and Accessibility of Rehabilitation Services in a Rural District of South Africa: A Mixed-Methods Study

“…These services include, amongst others, physiotherapy, occupational therapy, speech and language therapy, orthotics and prosthetics and audiology services. In addition to having individual benefits for users, rehabilitation services have also been shown to result in cost savings greater than initial investments [ 2 ]. Moreover, the growing need for rehabilitation services across countries means that providing rehabilitation services will be a key strategy if the health-related Sustainable Development Goals are to be achieved [ 1 , 3 , 4 , 5 ].…”