Cost-effectiveness of Seven-days-per-week Rehabilitation Schedule for Acute Stroke Patients

Ah, the stupidity of cost research  rears its' ugly head again rather than researching results or recovery effectiveness.

Cost-effectiveness of Seven-days-per-week Rehabilitation Schedule for Acute Stroke Patients

Yasuhiro Morii, Kagari Abiko, Toshiya Osanai, Jiro Takami, Takumi Tanikawa, Kensuke Fujiwara, Kiyohiro Houkin, Katsuhiko Ogasawara

DOI:

10.21203/rs.3.rs-1489462/v1

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Background: Rehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of seven-days-per-week rehabilitation schedule has been studied in comparison with five- or six-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of seven-days-per-week rehabilitation for acute stroke from public health payer’s perspective, and public healthcare and long-term care payerʼs perspective in Japan.

Methods: Cost-effectiveness of seven-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a study using a Japanese database examining the efficacy of seven-days-per-week rehabilitation. Cost utility analysis was conducted by comparing seven-days-per-week rehabilitation with five- or six-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years. The incremental costs analyzed included medical costs and long-term care costs, estimated using the Japanese fee table and published sources. Analysis period was five years, and Markov modeling was used for the analysis.

Results: The ICER was $10,901/ QALY from public health payer’s perspective, lower than 5,000,000 Yen/ QALY (approximately US$43,055), which was the threshold used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payerʼs perspective. The result of sensitivity analysis showed that even when the lowest efficacy of was assumed, the ICER was $39,065/QALY.

Conclusion: The results indicated that seven-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective, with a little uncertainty with uncertainty in patient outcome.