Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: the Czech Republic perspective.

Autor:	Angerova Y; Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha., Marsalek P; Department of Rehabilitation, Krajská zdravotní, a.s., Masaryk Hospital in Ústí nad Labem, Ústí nad Labem., Chmelova I; Clinic of Rehabilitation and Physical Medicine.; Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava., Gueye T; Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha., Uherek S; Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno., Briza J; Surgical Clinic, General University Hospital, Praha., Bartak M; Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Praha.; Faculty of Health Studies, J. E. Purkyně University in Ústí nad Labem, Czech Republic., Rogalewicz V; Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha.
Jazyk:	angličtina
Zdroj:	International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation [Int J Rehabil Res] 2020 Dec; Vol. 43 (4), pp. 376-382.
DOI:	10.1097/MRR.0000000000000440
Abstrakt:	The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4-69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.
Databáze:	MEDLINE
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