What the hell, NOTHING on effectiveness of the rehab provided.
Cost-effectiveness of a high-intensity rapid access outpatient stroke rehabilitation program
Abstract
A common strategy to improve cost-effectiveness in healthcare is to
offer outpatient care instead of in-hospital care. Toronto
Rehabilitation Institute developed an outpatient high-intensity
fast-track (FT) stroke rehabilitation program aimed at discharging
inpatient stroke rehabilitation patients earlier or bypassing inpatient
rehabilitation altogether. This cost-effectiveness analysis compares FT
rehabilitation within 1 week of discharge with no FT in a single
healthcare payer system. Patient costs and outcomes over a 12-week time
horizon were included. Using individual-level FT data from April 2015 to
March 2016, incremental cost-effectiveness ratios (ICERs) (with 95%
confidence interval) were estimated using regression. Subgroup analysis
was completed for patients entering FT directly from inpatient
rehabilitation and acute stroke care. Uncertainty was assessed using a
cost-effectiveness acceptability curve with a range of
willingness-to-pay values ($0-1000 per inpatient day saved). ICER (95%
confidence interval) estimate for patients entering FT from inpatient
rehabilitation was $404 ($270-620) per inpatient day saved. ICER
estimate for direct from acute care admissions was $37 ($20-55) per day
saved. At willingness-to-pay of $698 (cost of one alternate level of
care day in acute care awaiting rehabilitation), the probability of FT
being cost-effective was 99.2 and 100% for patients from inpatient
rehabilitation and acute stroke care, respectively. From a single
healthcare payer perspective, FT is a cost-effective method of providing
appropriate rehabilitation intensity for stroke patients early on, and
likely to provide savings to the healthcare system upstream through
fewer days awaiting rehabilitation admission.
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