Abstract
Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. The objective of this review was to assess the evidence on the relative cost or cost-effectiveness of all integrated care arrangements for stroke patients compared to usual care. Integrated care was defined as a multidisciplinary tool to improve the quality and efficiency of evidence-based care and is used as a communication tool between professionals to manage and standardize the outcome-orientated care. A systematic literature review of cost analyses and economic evaluations was performed. Study characteristics, study quality and results were summarized. Fifteen studies met the inclusion criteria; six on early-supported discharge services, four on home-based rehabilitation, two on stroke units and three on stroke services. The follow-up per patient was generally short; one year or less. The comparators and the scope of included costs varied between studies. Six out of six studies provided evidence that the costs of early-supported discharge are less than for conventional care, at similar health outcomes. Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes. Care in stroke units is more expensive than conventional care, but leads to improved health outcomes. The cost-effectiveness studies on integrated stroke services suggest that they can reduce costs. For future research we recommend to focus on the moderate and severely affected patients, include stroke severity as variable, adopt a societal costing perspective and include long-term costs and effects.
Highlights
Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation
Home-based rehabilitation is unlikely to lead to cost-savings, but achieves better health outcomes
Care in stroke units is more expensive than conventional care, but leads to improved health outcomes
Summary
Given the high incidence of stroke worldwide and the large costs associated with the use of health care resources, it is important to define cost-effective and evidence-based services for stroke rehabilitation. In many Western countries, stroke is the biggest single cause of disabi lity [1]. It should not come as a surprise that the economic burden of stroke is very large. Apart from the costs to the health system and rehabilitation services, there are the production losses to society rising from premature deaths and disability, and costs to the individual and families who have to take time off from work to provide informal care. The extent of the problem, combined with limited health care budgets emphasizes the need for an evidence-based and costeffective health care delivery in stroke care
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