Cost-Effectiveness of Intermediate Care (inpatient) in Post-Acute Stroke Compared with Out-Patient Rehabilitation Program
Keywords:
Intermediate care, Post-acute stroke, RehabilitationAbstract
Rehabilitation service is necessary for post-acute stroke patients in order to recover as normal or near normal people.Intermediate care (IMC) was inpatient 14-days rehabilitation program with intensive rehabilitation training and multidisciplinary care team which was proposed in healthcare system. However, some patients had still received out-patient (OPD) rehabilitation program for their recovery (24 times rehabilitation training within 6 months). This study aimed to perform cost-effectiveness analysis of IMC compared with OPD rehabilitation program in a view point of society. Direct medical cost, direct-non medical cost, indirect cost was collected. We measured activity daily living (ADL) using Barthel index (BI) and utility with EQ-5D-5L. Incremental cost-effectiveness ratio (ICER) was done to present the efficiency of IMC and willingness to pay threshold was160,000 THB per QALY gain. The results showed IMC was cost-effective in patients with low Barthel index score. ICER per QALY was 24,821.20 THB and 148,927.20 in BI score group less than 11 and 11-19 respectively. Sensitivity analysis showed that decreased costs of IMC were important factors of cost-effectiveness. We concluded IMC was cost-effective in post-acute stroke patients with impairment daily life compared with out-patient rehabilitation program.
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