Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
PharmacoEconomics
Published in: PharmacoEconomics 8/2002

01-07-2002 | Original Research Article

Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care

An Overview and Cost Analysis

Authors: Professor Craig Anderson, Cliona Ni Mhurchu, Paul M. Brown, Kristie Carter

Published in: PharmacoEconomics | Issue 8/2002

Login to get access

Abstract

Background: Limited information exists on the best way to organise stroke rehabilitation after hospital discharge and the relative costs of such services.
Objective: To review the evidence of the cost effectiveness of services that accelerate hospital discharge and provide home-based rehabilitation for patients with acute stroke.
Methods: A systematic review with economic analysis of published randomised clinical trials (available to March 2001) comparing early hospital discharge and domiciliary rehabilitation with usual care in patients with stroke was conducted. From included studies, data were extracted on study quality; major clinical outcomes including hospital stay, death, institutionalisation, disability, and readmission rates; and resource use associated with hospital stay, rehabilitation, and community services. The resources were priced using Australian dollars ($A) healthcare costs. The outcomes and costs of the new intervention were compared with standard care.
Results: Seven published trials involving 1277 patients (54% men; mean age 73 years) were identified. The pooled data showed that overall, a policy of early hospital discharge and domiciliary rehabilitation reduced total length of stay by 13 days [95% confidence interval (CI): -19 to -7 days]. There was no significant effect on mortality (odds ratio = 0.95; 95% CI: 0.65 to 1.38) or other clinical outcomes making a cost minimisation analysis for the economic analysis appropriate. The overall mean costs were approximately 15% lower for the early discharge intervention [$A16 016 ($US9941) versus $A18 350 ($US11 390)] compared with standard care.
Conclusions: A policy of early hospital discharge and home-based rehabilitation for patients with stroke may reduce the use of hospital beds without compromising clinical outcomes. Our analysis shows this service to be a cost saving alternative to conventional in-hospital stroke rehabilitation for an important subgroup of patients with stroke-related disability.
Literature
1.
Warlow CP, Dennis MS, van Gijn J, et al. Stroke: a practical guide to management. Edinburgh: Blackwell Science, 1996
2.
Jamrozik K, Broadhurst RJ, Lai N, et al. Trends in the incidence, severity and short-term outcome of stroke in Perth, Western Australia. Stroke 1999; 30: 2105–11PubMedCrossRef
3.
Anderson CS, Jamrozik KD, Stewart-Wynne EG. Patterns of acute hospital care, rehabilitation, and discharge disposition after acute stroke: the Perth Community Stroke Study 1989–1990. Cerebrovasc Dis 1994; 4: 344–53CrossRef
4.
Isard PA, Forbes JF. The cost of stroke to the National Health Service in Scotland. Cerebrovasc Dis 1992; 2: 47–50CrossRef
5.
Aho K, Harmsen P, Hatano S, et al. Cerebrovascular disease in the community: results of a WHO Collaborative Study. Bull World Health Organ 1980; 58: 113–30PubMed
6.
Stroke Unit Trialists’ Collaboration. Collaborative systematic review of the randomised trials of organised in-patient (stroke unit) care after stroke. BMJ 1997; 314: 1151–9CrossRef
7.
Organising Committee. Asia Pacific consensus forumon stroke management. Stroke 1998; 29: 1730–6CrossRef
8.
European Ad Hoc Consensus Group. European strategies for early intervention in stroke: a report of an ad hoc consensus group meeting. Cerebrovasc Dis 1996; 6: 315–24CrossRef
9.
10.
11.
Early Supported Discharge Trialists. Services for reducing duration of hospital care for acute stroke patients (Cochrane Review). Available in The Cochrane Library [database on disk and CD ROM]. Updated quarterly. The Cochrane Collaboration; issue 3. Oxford: Update Software, 2000
12.
Beech R, Rudd AG, Tilling K, et al. Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke 1999; 30: 729–35PubMedCrossRef
13.
Anderson C, Ni Mhurchu C, Rubenach S, et al. Home or hospital for stroke rehabilitation? Results of a randomised controlled trial. II: costminimisation analysis at 6 months. Stroke 2000; 31: 1032–7PubMedCrossRef
14.
McNamee P, Christensen J, Soutter J, et al. Cost analysis of early supported hospital discharge for stroke. Age Ageing 1998; 27: 345–51CrossRef
15.
Widen Holmqvist L, de Pedro Cuesta J, Moller G, et al. A pilot study of rehabilitation at home after stroke: a health-economic appraisal. Scand J Rehabil Med 1996; 28: 9–18PubMed
16.
Anderson C, Rubenach S, Ni Mhurchu C, et al. Home or hospital for stroke rehabilitation? Results of a randomised controlled trial. I: health outcomes at 6 months. Stroke 2000; 31: 1024–31PubMedCrossRef
17.
Australian Hospital Cost Data Collection, 1998/99. Final report of the development of AR-DRG, version 4.1, August 2000. Available from URL: http://​www.​health.​gov.​au [Accessed 2002 Jun 19]
18.
Normand ST. Tutorial in biostatistics: meta-analysis: formulating, evaluation, combining, and reporting. Stat Med 1999; 18: 321–59PubMedCrossRef
19.
Mantel W, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 1959; 22: 710–48
20.
Hedges LV, Olkin I. Statistical methods for meta-analysis. New York (NY): Academic Press, 1985
21.
22.
Microsoft Excel 97 SR-2 [computer program]. Seattle (WA): Microsoft Corporation, 1985-1997
23.
S-PLUS 2000 [computer program]. Professional release 2. Cambridge (MA): Mathsoft Inc., 1999
24.
Rodgers J, Soutter J, Kaiser W, et al. Early supported hospital discharge following acute stroke: pilot study results. Clin Rehabil 1997; 11: 280–7PubMedCrossRef
25.
Widén Holmqvist L, von Koch L, Kostulas V, et al. A randomised controlled trial of rehabilitation at home after stroke in Southwest Stockholm. Stroke 1998; 29: 591–7PubMedCrossRef
26.
Mayo NE, Wood-Dauphinee S, Côté R, et al. There’s no place like home: an evaluation of early supported discharge for stroke. Stroke 2000; 31: 1016–23PubMedCrossRef
27.
Rudd AG, Wolfe CD, Tilling K, et al. Randomised controlled trial to evaluate early discharge scheme for patients with stroke. BMJ 1997; 315: 1039–44PubMedCrossRef
28.
Ronning OM, Guldvog B. Outcome of subacute stroke rehabilitation: a randomized controlled trial. Stroke 1998; 29: 779–84PubMedCrossRef
29.
Indredravik B, Fjaertoft H, Ekeberg G, et al. Benefit of an extended stroke unit service with early supported discharge: a randomized, controlled trial. Stroke 2000; 31: 2989–94CrossRef
30.
Annual report 1996–1997. Canberra: Australian Commonwealth Department of Health and Family Services, 1997
31.
Brandstater ME. An overview of stroke rehabilitation: a review. Stroke 1986; 17: 363–9CrossRef
32.
Lafferty G. Community-based alternatives to hospital rehabilitation services: a review of the evidence and suggestions for approaching future evaluations. Rev Clin Gerontol 1996; 6: 183–94CrossRef
33.
Gladman JRF, Lincoln NB, for the DOMINO Study Group. Follow-up of a controlled trial of domiciliary stroke rehabilitation (DOMINO Study). Age Ageing 1994; 23: 9–13PubMedCrossRef
34.
Young JB, Forster A. The Bradford community stroke trial: results at six months. BMJ 1992; 304: 1085–9PubMedCrossRef
35.
Baskett JJ, Broad JB, Reekie G, et al. Shared responsibility for ongoing rehabilitation: a new approach to home-based therapy after stroke. Clin Rehabil 1999; 13: 23–33PubMedCrossRef
Metadata
Title
Stroke Rehabilitation Services to Accelerate Hospital Discharge and Provide Home-Based Care
An Overview and Cost Analysis
Authors
Professor Craig Anderson
Cliona Ni Mhurchu
Paul M. Brown
Kristie Carter
Publication date
01-07-2002
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 8/2002
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.2165/00019053-200220080-00004

Other articles of this Issue 8/2002

PharmacoEconomics 8/2002 Go to the issue

Original Research Article

Economic Benefits of Amlodipine Treatment in Patients with Coronary Artery Disease

Review Article

Cost-Effective Approaches to the Treatment of Community-Acquired Pneumonia in the Era of Resistance

Current Opinion

Methods for Claims-Based Pharmacoeconomic Studies in Psychosis

Original Research Article

Ready-to-Use Injection Preparations versus Conventional Reconstituted Admixtures