Abstract
BackgroundThe delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. Primary care teams are entrusted to provide longer term care for stroke survivors in most developing countries. The integrated Care Pathway for Post Stroke patients (iCaPPS©) was designed to guide primary care teams to incorporate further rehabilitation and regular screening for post stroke complications among patients residing at home in communities, using the shared-care approach, especially in areas with limited access to specialist stroke care services. The iCaPPS© addressed coordination of rehabilitation and screening for post stroke complications which were absent in the current conventional care of patients managed at public primary care healthcentres. This study aimed to evaluate the cost effectiveness and impact of iCaPPS© on quality-adjusted- life-years (QALY) compared with current conventional monitoring at public primary care healthcentres.MethodsA pragmatic healthcentre-based cluster randomised controlled trial-within trial on 151 post stroke patients from 10 public primary care facilities in Peninsular Malaysia was conducted to evaluate QALY of patients managed with iCaPPS© (n = 86) vs conventional care (n = 65) for 6 months. Costs from societal perspective were calculated, using combination of top down and activity-based costing methods. The 5-level EQ5D (EQ-5D-5 L) was used to calculate health state utility scores. Cost per QALY and incremental cost effectiveness ratio (ICER) were determined. Differences within groups were determined using Mann-Whitney tests.ResultsTotal costs for 6 months treatment with iCaPPS© was MYR790.34, while conventional care cost MYR527.22. Median QALY for iCaPPS© was 0.55 (0,1.65) compared to conventional care 0.32 (0, 0.73) (z = − 0.21, p = 0.84). Cost per QALY for iCaPPS© was MYR1436.98, conventional care was MYR1647.56. The ICER was MYR1144.00, equivalent to 3.7% of per capita GDP (2012 prices).ConclusionsManagement of post stroke patients in the community using iCaPPS© costs less per QALY compared to current conventional care and is very cost effective.Trial registrationTrial Registration number ACTRN12616001322426. Registered 21 September 2016. (Retrospectively registered).
Highlights
The delivery of post stroke care is fragmented even in advanced public healthcare systems, globally
Developing countries face greater challenges in providing optimal post stroke care when resources are prioritised to providing specialist care services, which may not be accessible to the majority
Aims / hypothesis The aim of this study was to undertake a cost effectiveness analysis of the implementation of integrated Care Pathway for Post Stroke patients (iCaPPS©)compared to conventional post stroke care from societal perspective, using the Euroqol EQ-5D-5 L
Summary
The delivery of post stroke care is fragmented even in advanced public healthcare systems, globally. The iCaPPS© addressed coordination of rehabilitation and screening for post stroke complications which were absent in the current conventional care of patients managed at public primary care healthcentres. Developing countries face greater challenges in providing optimal post stroke care when resources are prioritised to providing specialist care services, which may not be accessible to the majority. Patients receive treatment during acute phase at hospitals, and will be discharged after a 5–7-day stay [3, 4] Patients and their caregivers will have to fend for themselves, based on whatever facilities available in the community. For those who did not have access to hospitals during the acute stroke period, will eventually seek out treatment from their primary care provider. To ensure equity in healthcare service provision in developing countries, where most specialist stroke care services are based in urban areas, shared care approaches with the primary healthcare services becomes a necessity
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