Cost-effectiveness of Intensive Intermediate Care Rehabilitation for Stroke Patients in Nopparat Rajathanee Hospital: A retrospective Observational Study
Keywords:Barthel index, cost-effectiveness, rehabilitation, right hemispheric stroke
Objectives: To study the cost-effectiveness of intensive intermediate care rehabilitation using direct cost and effectiveness for inpatient and outpatient stroke patients in Nopparat Rajathanee Hospital.
Study design: Retrospective observational study.
Setting: The rehabilitation and stroke units, Nopparat Rajathanee Hospital, Bangkok, Thailand.
Subjects: Intensive intermediate care rehabilitation stroke patients during October 2021 - September 2022.
Methods: Demographic data, Barthel index at admission (BIA), and Barthel index at discharge (BID) were obtained from medical records. BI gain (BID-BIA) and percentage of rehabilitation effec-tiveness ((BID-BIA)/(BI max-BIA) x 100) were calculated. In addition, capital cost, labor cost, and materials cost of health care providers were determined.
Results: Thirty-four stroke patients were recruited into this study: 52.9% were males, 90.9% had an ischemic stroke, and the mean age was 56 years (SD 13.71). At discharge, the average BI had increased significantly over the value at admission (p < 0.05), with a mean BI gain of 5.09 (SD 2.30) in inpatient rehabilitation and 4.77 (SD 2.26) in outpatient rehabilitation. The mean rehabilitation effectiveness percentage was 47.4 in inpatient rehabilitation and 53.0 in outpatient rehabilitation. The average direct cost of inpatient rehabilitation was 21,000 THB (600 USD)/person/admission or 1,500 THB (43 USD)/day. The average direct cost of outpatient rehabilitation was 399 THB (11 USD)/person/day. The average direct cost per 1 point improvement in the Barthel index was 4,127 THB (118 USD) in inpatient and 1,171 THB (33 USD) in outpatient rehabilitation
Conclusions: Intensive intermediate care rehabilitation for stroke patients in Nopparat Rajathanee Hospital statistically significantly improved BI scores. Rehabilitation effectiveness in this study was close to the results in a previous study. The direct cost of inpatient and outpatient stroke rehabilitation in Nopparat Rajathanee Hospital should continue to be used to determine cost-effectiveness.
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