Cost-effectiveness of home-based stroke rehabilitation across Europe: A modelling study

You have got to be kidding, this is complete insanity. There is not a stroke survivor in the world who cares about cost, they want to know how you are getting them 100% recovered. I would have the mentors and senior researchers fired for approving this crapola. 

Cost-effectiveness of home-based stroke rehabilitation across Europe: A modelling study

Author links open overlay panelPaoloCandio^abMaraViolato^aRamonLuengo-Fernandez^a

JoseLeal^a

https://doi.org/10.1016/j.healthpol.2022.01.007Get rights and content

Abstract

The aim of this study was to explore the cost-effectiveness of home-based versus centre-based rehabilitation in stroke patients across Europe. A state-transition cohort model was developed to simulate the impact of the intervention in 32 European countries. A cost-utility analysis was conducted from a societal perspective including healthcare, social care and informal care costs, and productivity losses. Health outcomes were expressed as QALYs. Sensitivity analyses were conducted concerning model input values and structural assumptions. Data were obtained from a population-based cohort and previously published studies. Across Europe, over 855,000 patients with stroke would be eligible for rehabilitation in 2017. Europe-wide implementation of home-based rehabilitation was estimated to produce 61,888 additional QALYs (95% CI: 3,609 to 118,679) and cost savings of €237 million (95% CI: -237 to 1,764) and of €352 million (95% CI: -340 to 2,237) in health- and social-care and societal costs, respectively. Under base case assumptions, home-based rehabilitation was found highly likely to be cost-effective (>90%), compared to centre-based rehabilitation, in most European countries (29 out of 32). Evidence from this study suggests that a shift from a centre-based to a home-based approach to stroke rehabilitation is likely to be good value for money in most European countries. Further research should be conducted to assess the generalisability of these findings to local settings.

Introduction

Stroke is one of the leading causes of global disability. [1] In Europe, 1.5 million people are diagnosed with stroke every year, costing European societies in excess of €60 billion annually [2]. Stroke affects patients’ activities of daily living [3], [4], with many having to rely on the health and social care system, as well as on informal carers, for their care [5].

While remarkable improvements have been achieved in terms of reduction of stroke incidence over the last two decades [6], demographic projections have shown that European populations are ageing [7]. This implies that the economic burden of stroke will likely increase in the future, with more pressure put on European healthcare budgets as a result. There are, therefore, strong incentives for policymakers to commission stroke interventions that provide good value for money.

Rehabilitation is an integral part of stroke patient care [8], [9], [10] and has received increasing research attention over the last two decades [11]. A Cochrane review found clear evidence that organised inpatient care (stroke unit) is more likely to result in better recovery and disability-related outcomes, compared to generic hospital wards [12]. Nonetheless, increased pressure on hospitals and inpatient centres has meant that new rehabilitation approaches outside the hospital setting ought to be considered as well [13], [14], [15].

Another systematic review evaluated the effectiveness of home-based compared to centre-based (outpatient clinic or day hospital settings) rehabilitation for stroke patients. It found a significant effect in favour of home-based rehabilitation (HB) [16]. The aim of this study is, therefore, to explore the cost-effectiveness of HB compared to centre-based rehabilitation (CB) for stroke survivors across European countries.