Assessing the impact of a home-based stroke rehabilitation programme: a cost-effectiveness study

<p><b>Background:</b> Stroke is often a severe and debilitating event that requires ongoing rehabilitation. The Community Stroke Rehabilitation Teams (CSRTs) offer home-based stroke rehabilitation to individuals for whom further therapy is unavailable or inaccessible. The objective of this study was to evaluate the cost-effectiveness of the CSRT programme compared with a “Usual Care” cohort.</p> <p><b>Methods:</b> We collected data on CSRT clients from January 2012 to February 2013. Comparator data were derived from a study of stroke survivors with limited access to specialised stroke rehabilitation. Literature-derived values were used to inform a long-term projection. Using Markov modelling, we projected the model for 35 years in six-month cycles. One-way, two-way, and probabilistic sensitivity analyses were performed. Results were discounted at 3% per year.</p> <p><b>Results:</b> Results demonstrated that the CSRT programme has a net monetary benefit (NMB) of $43,655 over Usual Care, and is both less costly and more effective (incremental cost = −$17,255; incremental effect = 1.65 Quality Adjusted Life Years [QALYs]). Results of the probabilistic sensitivity analysis revealed that incremental cost-effectiveness of the CSRT programme is superior in 100% of iterations when compared to Usual Care.</p> <p><b>Conclusions:</b> The study shows that CSRT model of care is cost-effective, and should be considered when evaluating potential stroke rehabilitation delivery methods.Implications for Rehabilitation</p><p>Ongoing rehabilitation following stroke is imperative for optimal recovery.</p><p>Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.</p><p>The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.</p><p></p> <p>Ongoing rehabilitation following stroke is imperative for optimal recovery.</p> <p>Home-based specialised stroke rehabilitation may be an option for individuals for whom ongoing rehabilitation is unavailable or inaccessible.</p> <p>The results of this study demonstrated that home-based rehabilitation is a cost-effective means of providing ongoing rehabilitation to individuals who have experienced a stroke.</p

First Angiotensin Receptor Blocker Prescription Filled After Hospital Discharge.

<p>First Angiotensin Receptor Blocker Prescription Filled After Hospital Discharge.</p

First Angiotensin-Converting Enzyme Inhibitor Prescription Filled After Hospital Discharge.

<p>First Angiotensin-Converting Enzyme Inhibitor Prescription Filled After Hospital Discharge.</p

Patient characteristics and prescription outcomes for PPI, ACE inhibitor and ARB groups.

*<p>Proton pump inhibitor: omeprazole, pantoprazole, lansoprazole or rabeprazole.</p>†<p>Angiotensin-converting enzyme inhibitor: ramipril, enalapril (maleate and sodium), quinapril, fosinopril, lisinopril, benazepril, perindopril, cilazapril or trandolapril.</p>‡<p>Angiotensin receptor blocker: losartan, candesartan, irbesartan, valsartan, telmisartan or eprosartan.</p>§<p>As defined by Charlson comorbidity index <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039737#pone.0039737-Furuta1" target="_blank">[26]</a>.</p

Cost of discharge prescriptions, potential Savings with inexpensive agent and cost of inpatient drug coverage for PPI, ACE inhibitors and ARBs.

*<p>Proton pump inhibitor: omeprazole, pantoprazole, lansoprazole or rabeprazole.</p>†<p>Angiotensin-converting enzyme inhibitor: ramipril, enalapril (maleate and sodium), quinapril, fosinopril, lisinopril, benazepril, perindopril, cilazapril or trandolapril.</p>‡<p>Angiotensin receptor blocker: losartan, candesartan, irbesartan, valsartan, telmisartan or eprosartan.</p

Cost in $ CAN of one pill at equivalent doses for PPI, ACE inhibitors and ARB groups^*.

*<p>Cost obtained from Ontario Drug Benefit formulary prices in effect from April 1^st 2008 to March 31st 2010 <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039737#pone.0039737-Quan1" target="_blank">[27]</a>.</p>†<p>Proton pump inhibitor: omeprazole, pantoprazole, lansoprazole or rabeprazole.</p>‡<p>Angiotensin-converting enzyme inhibitor: ramipril, enalapril (maleate and sodium), quinapril, fosinopril, lisinopril, benazepril, perindopril, cilazapril or trandolapril.</p>¶<p>Angiotensin receptor blocker: losartan, candesartan, irbesartan, valsartan, telmisartan or eprosartan.</p

First Proton Pump Inhibitor Prescription Filled After Hospital Discharge.

<p>First Proton Pump Inhibitor Prescription Filled After Hospital Discharge.</p