Cost-effectiveness of Intensive Intermediate Care Rehabilitation for Stroke Patients in Nopparat Rajathanee Hospital: A retrospective Observational Study


  • Kotchakorn Yanyong Department of Rehabilitation Medicine, Nopparat Rajathanee Hospital, Bangkok


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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Tiamkao S. Current situation of stroke in Thailand. Thai Journal of Neurology [Internet]. 2021 Jul [cited 2022 Sep 19];37(3):[about 1 p.]. Available from

Ministry of Public Health. Office of the Permanent Secretary. Health Administration Division. Guideline for intermediate care service plan: care guidelines. Samut Sakhon: Born to be publishing; 2562. [cited 2022 Sep 19]. p. 25-31. Available from:

Sub-Committee on Health Care Service System Development Plan. Guideline on intermediate care for medical personnel under health care service system development plan (service plan). Samut Sakhon: Born to be publishing; 2019.

Kuptniratsaikul V, Kovindha A, Dajpratham P, Piravej K. Main outcomes of stroke rehabilitation: a multi-centre study in Thailand. J Rehabil Med [Internet]. 2009 [cited 2022 Sep 19];41:54-8. Available from

Salter K, Jutai J, Hartley M, Foley N, Bhogal S, Bayona N, et al. Impact of early vs delayed admission to rehabilitation on functional outcomes in persons with stroke. J Rehabil Med [Internet]. 2006 [cited 2022 Sep 19];38:113-7. Available from

Committee of Subacute Rehabilitation Care Project. The Thai Rehabilitation Medicine Association. Development of subacute rehabilitation program and lesson learned from the Ministry of Public Health. [Internet]. 2018. [cited 2022 Sep 19]. Available from

Stefano P, Gabriella A, Maria G, Daniela M, Elio T, Paola C, et al. Early versus delayed inpatient stroke rehabilitation: a matched comparison conducted in Italy. Arch Phys Med Rehabil [Internet]. 2000 [cited 2022 Sep 19];81:695-700. Available from

Sribundit N, Riewpaiboon A, Chaikledkaew U, Stewart J, Tantirittisak T, Hanchaipiboolkul S. Cost of acute care for ischemic stroke in Thailand. [Internet]. 2017. [cited 2022 Sep 19]. Available from

Kuptniratsaikul K, Kovindha A, Massakulpan P, Permsirivanish W, Srisa-an Kuptniratsaikul P. Inpatient rehabilitation service for patient after stroke in Thailand: a multi-centre study. J Rehabil Med [internet]. 2009 [cited 2022 Sep 19];41:684-6. Available from

Saringcarinkul T. Intermediate care of neurological patients. In: Kanesaku T, editor. Best practice in stroke management. Bangkok: Tanaplace; 2021. p. 29-39.

Riewpaiboon A. Measurement of costs. J Med Assoc Thai [Internet]. 2008 [cited 2022 Sep 19];91:28-37. Available from

Kuptniratsaikul V. Conclusions of multi-center study from Thai stroke rehabilitation registry. J Thai Rehabil Med. 2010;20:103-8.

Chayaratanasin P, Roongsaiewatana S, Chira- W. Functional outcomes, effectiveness and efficiency of stroke rehabilitation services in Ramathibodi hospital: a prospective descriptive study. ASEAN J Rehabil Med [internet]. 2022 [cited 2022 Sep 19];32:123-30. Available from

Pattanasuwanna P. Outcomes of intermediate phase post-stroke inpatient rehabilitation in community hospital. J Thai Rehabil Med [internet]. 2019 [cited 2022 Sep 19];29:8-13. Available from

Kuptniratsaikul V, Wattanapan P, Wathanadilokul U, Sukonthamarn K, Lukkanapichonchut P, Ingkasuthi K, et al. The effectiveness and efficiency of inpatient rehabilitation services in Thailand: a prospective multi-center study. Rehabil Process Outcome [Internet]. 2016 [cited 2022 Sep 19];5:13-8. Available from doi: 10.4137/RPO.S34816

Suksathien R. Accessibility to medical rehabilitation service for acute stroke at Maharat Nakhon Ratchasima Hospital: Related factors and outcomes. J Thai Rehabil Med [internet]. 2014 [cited 2022 Sep 19];24:37-43. Available from

Riewpaiboon W. Cost analysis of rehabilitation service at Sirindhon national medical rehabilitation center [Internet]. Bangkok: National library of Thailand; 2001. [cited 2022 Sep 19]. Available from:

Charoenwiwatanakul D, Dajpratham P. Unit cost of inpatient stroke rehabilitation. J Thai Rehabil Med [internet]. 2008 [cited 2022 Sep 19];18:85-9. Available from