PS1-12 A COST-EFFECTIVENESS STUDY OF HOME-BASED STROKE REHABILITATION

Sunday, October 18, 2015
Grand Ballroom EH (Hyatt Regency St. Louis at the Arch)
Poster Board # PS1-12

Laura Allen, M.Sc.1, Ava John-Baptiste, PhD2, Marina Richardson, M.Sc.3, Matthew Meyer, Ph.D1, Mark Speechley, Ph.D1, David Ure4, Deb Willems5 and Robert Teasell, MD6, (1)Western University, Department of Epidemiology and Biostatistics, London, ON, Canada, (2)Western University, London, ON, Canada, (3)Lawson Health Research Institute, Aging, Rehabilitation and Geriatric Care, London, ON, Canada, (4)St. Joseph's Health Care, London, London, ON, Canada, (5)Southwestern Ontario Stroke Network, London, ON, Canada, (6)Schulic School of Medicine and Dentistry, London, ON, Canada
Purpose:

Rehabilitation after discharge from hospital is important for recovery after stroke. Evidence for the cost-effectiveness of both home and hospital-based programs is limited. Our aim was to determine the cost-effectiveness of a home-based, stroke rehabilitation program compared to no rehabilitation, for patients who have limited access to rehabilitation services. Southwestern Ontario’s Community Stroke Rehabilitation Teams (CSRTs) provide interdisciplinary rehabilitation directly in a person’s home. We hypothesized that home-based stroke rehabilitation will be cost-effective when compared to no further therapy.

Method:

We developed a Markov Model to compare the cost and quality-adjusted life years (QALYs) between CSRT clients and patients with no rehabilitation. Data on costs and utilities were derived from three sources: 1. CSRT data were taken from a prospective study of the program in which functional outcomes, EQ-5D utilities, and health and social services utilization was collected over 12 months. 2. Cost data for stroke patients with no rehabilitation were taken from an Ontario-based study in which functional outcomes and health service utilization were collected over 12 months. 3. Peer-reviewed literature-derived costs, utilities, and transition probabilities were used to inform model parameters for long term projection for both the control and intervention arms. A cost-effectiveness analysis was performed with one-way, two-way and probabilistic sensitivity analyses (PSA) conducted to assess the impact of uncertainty on the model results. Net Monetary Benefit (NMB) was calculated using a Willingness to Pay of $20,000/ QALY. The perspective of the analysis was Societal. The model time horizon was 35 years. Costs and utilities were discounted at a rate of 3% per annum.

Result:

The incremental cost saving of CSRT compared to No Therapy was $21,515 and incremental effect was 1.08 QALYs. PSA revealed a NMB of $42,535 (95% CI: $23,762 to $61,307) in favour of CSRT. Thus the CSRT was dominant being both less costly and more effective than no further therapy.

Conclusion:

Our model suggests that CSRT is cost-effective when compared to no further therapy. The cost savings result from the increased number of individuals making functional improvements.  Furthermore, the therapy increases the average health-related quality of life of these individuals. The CSRT model of care should be considered when developing future home-based stroke rehabilitation programs.

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