Abstract
ObjectiveStroke remains a leading cause of premature death, impairment and reduced quality of life. Its aftercare is performed by numerous different health care service providers, resulting in a high need for coordination. Personally delivered patient navigation (PN) is a promising approach for managing pathways through health care systems and for improving patient outcomes. Although PN in stroke care is evolving, no summarized information on its cost-effectiveness in stroke survivors is available. Hence, the aim of this systematic review is to analyze the level of evidence on the cost-effectiveness of PN for stroke survivors.MethodsA systematic literature search without time limitations was carried out in PubMed, EMBASE, CENTRAL, CINAHL as well as PsycINFO and supplemented by a manual search. Randomized controlled trials published prior to April 2020 in English or German were considered eligible if any results regarding the cost-effectiveness of PN for stroke survivors were reported. The review was conducted according to PRISMA guidelines. Quality of included studies was assessed with the RoB2 tool. Main study characteristics and cost-effectiveness results were summarized and discussed.ResultsThe search identified 1442 records, and two studies met the inclusion criteria. Quality of included studies was rated moderate and high. Programs, settings and cost-effectiveness results were heterogeneous, with one study showing a 90% probability of being cost-effective at a willingness to pay of $25600 per QALY (health/social care perspective) and the other showing similar QALYs and higher costs.ConclusionsSince only two studies were eligible, this review reveals a large gap in knowledge regarding the cost-effectiveness of PN for stroke survivors. Furthermore, no conclusive statement about the cost-effectiveness can be made. Future attempts to evaluate PN for stroke survivors are necessary and should also involve cost-effectiveness issues.
Highlights
Stroke is the second most common cause of death (5.5 million cases annually)
Randomized controlled trials published prior to April 2020 in English or German were considered eligible if any results regarding the cost-effectiveness of patient navigation (PN) for stroke survivors were reported
Since only two studies were eligible, this review reveals a large gap in knowledge regarding the cost-effectiveness of PN for stroke survivors
Summary
Its burden on health care systems remains high, with 13.7 million annual incident cases worldwide [1]. Strokes are mostly associated with psychological, cognitive and physical impairments, which become more onerous with increasing severity [2]. Due to these impairments, the risk of hospital readmission post stroke is high, and the costs of post stroke care can be very high, depending on severity and the length of hospital stay [3, 4]. Care in general and the transition from hospital to outpatient care and rehabilitation in particular present many challenges These challenges include sufficient information or assistance in accessing health care after hospital discharge (e.g., locating services, scheduling appointments) as well as appropriate education and training regarding the transition to the home environment [7]
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