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

Frontiers in Cardiovascular Medicine

article

Yu-Ching Chen¹  Yu-Jo Yeh¹  Chung-Yuan Wang³  Hsiu-Fen Lin⁵  Ching-Huang Lin⁷  Hong-Hsi Hsien⁸  Kuo-Wei Hung⁹  Jung-Der Wang²  Hon-Yi Shi¹ 

[1] Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University;Department of Public Health, College of Medicine, National Cheng-Kung University;Department of Physical Medicine and Rehabilitation, Pingtung Christian Hospital;Department of Nursing, Meiho University;Department of Neurology, Kaohsiung Medical University Hospital;Department of Neurology, Kaohsiung Medical University;Division of Neurology, Kaohsiung Veterans General Hospital;Department of Internal Medicine, St. Joseph Hospital;Division of Neurology, Department of Internal Medicine, Yuan's General Hospital;Department of Medical Research, Kaohsiung Medical University Hospital;Department of Medical Research, China Medical University Hospital, China Medical University;Department of Business Management, National Sun Yat-sen University

关键词: postacute care;    cost-utility;    stroke;    incremental cost-utility ratios;    cost saving;   

DOI  :  10.3389/fcvm.2022.826898

学科分类：地球科学(综合)

来源: Frontiers

【 摘 要 】

Background Few 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. Methods This 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. Results At 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. Conclusions The 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.

【 授权许可】

CC BY