Economic evaluation of transferring first-stroke survivors to rehabilitation wards: A 10-year longitudinal, population-based study

ABSTRACT

Background: Transferring stroke survivors to the rehabilitation ward for rehabilitation reduces long-term mortality; however, the long-term economic impact remains unknown.

Objective: We aimed to assess the 10-year economic outcome of transferring first-stroke survivors to the rehabilitation ward.

Methods: In this population-based, retrospective study, we examined the incremental costs per life year gained (ICLYG) for stroke survivors who were transferred to the rehabilitation ward (TR) as compared to that for those who underwent rehabilitation without being transferred to the rehabilitation ward (R) and those who did not undergo rehabilitation (NR). The differences in the daily medical expenditures among the three groups during the 10-year post-stroke period were examined.

Results: After balancing characteristics of the three groups, the data of 14,544 first-stroke survivors between 1999 and 2003 were collected. The medical expenditure of index hospitalization was the lowest and the survival period was the longest in the TR group. The ICLYG of TR vs. NR (reference) was −388.5 (95% CI −396.2, −380.8) USD/year and that of TR vs. R (reference) was −121.5 (95% CI −130.4, −112.6) USD/year. The daily medical expenditure of the post-stroke survival period was significantly lower in the TR group (median 11.0, IQR 5.7–22.5 USD) than in the R (median 14.2, IQR 6.4–41.4 USD) and NR (median 19.5, IQR 6.4–88.2 USD) groups.

Conclusions: The 10-year post-stroke follow-up showed that transferring patients to the rehabilitation ward is more cost effective than rehabilitation without transfer to the rehabilitation ward and no rehabilitation.

KEYWORDS:

• Stroke
• rehabilitation
• medical expenditures
• cost-effectiveness
• economic evaluation

Acknowledgments

The authors thank the Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chia-yi Branch, for the comments and assistance in data analysis.

Supplemental data

Supplemental data for this article can be accessed here.

Disclosure of interest

The authors report no conflict of interest.