Financial impact of stroke

There is limited information about the impact of stroke on survivors' economic situation and most studies have been concerned with the impact of s…

Cost-effectiveness of stroke rehabilitation:  The economic burden of stroke includes vast direct costs:  health care, social and rehabilitation services and indirect costs such as the loss of productivity (R Anderson 1992; Gladman, Whynes and Lincoln 1994).  Direct costs alone consume considerable portions of national health care budgets in developed countries (Holmqvist et al 1995) and therefore health care authorities, policymakers and, above all, purchasers of health care services continually stress the importance of economic efficiency in service provision.  As a result of these pressures, the assessment of cost-effectiveness of stroke-related interventions has become more important in recent years (Holloway et al 1999). A full economic evaluation involves the comparison of both costs and effects of two or more programme alternatives (Drummond et al 1997).  In a cost-effectiveness analysis, the outcome of treatment can be assessed in different ways:  life-years gained, decreased length of hospital stay or decreased readmission rate.  In a cost-utility analysis, on the other hand, health improvement is expressed in quality-adjusted life years (QALYs).  Although QALYs are regarded as the most complicated way of quantifying effects, they are rarely used in economic evaluation studies of cerebrovascular accidents (Evers, Ament and Blaauw 2000). This variety of outcome measures is a major limitation when making comparisons between the various studies.  Several studies have compared the effects and the costs of a home-based rehabilitation scheme and an alternative treatment strategy after discharge from acute stroke care.  The results of the Bradford Community Stroke Trial showed that home physiotherapy was slightly advantageous over day hospital attendance and that the former was significantly less expensive (Young and Forster 1992).  In a domiciliary and hospital-based rehabilitation programme for stroke patients after discharge from hospital (DOMINO) study, patients discharged from geriatric wards were shown to be less likely to die or to be transferred to permanent care when they received day hospital services, but the cost of this service was 25 per cent more than home-based rehabilitation (Gladman and Lincoln 1994).  Domiciliary services, on the other hand, were significantly more expensive than hospital out-patient rehabilitation for patients discharged from general medical wards or from a stroke unit (Gladman, Whynes and Lincoln
1994).  Previous reports have demonstrated that specialised stroke units can improve outcome after stroke without increasing the cost of health care services (Eason, Bowie and Okpala 1995; Jorgensen et al 1995a). Hui  et al (1995) examined the effectiveness and cost of geriatric day hospital treatment and conventional medical management for elderly stroke survivors in Hong Kong.  They found that early discharge from a stroke ward followed by rehabilitation at a day hospital accelerated functional recovery and reduced outpatient visits without increasing costs.  CS Anderson et al (2000a,b), in the Perth Community Stroke Study, found that early hospital discharge and a home-based rehabilitation scheme were less costly than traditional hospital care and, if provided for the mildly disabled only, such services might well be most cost-effective