Cost-effectiveness of a high-intensity rapid access outpatient stroke rehabilitation program

A common strategy to improve cost-effectiveness in healthcare is to offer outpatient care instead of in-hospital care. Toronto Rehabilitation Institute developed an outpatient high-intensity fast-track (FT) stroke rehabilitation program aimed at discharging inpatient stroke rehabilitation patients earlier or bypassing inpatient rehabilitation altogether. This cost-effectiveness analysis compares FT rehabilitation within 1 week of discharge with no FT in a single healthcare payer system. Patient costs and outcomes over a 12-week time horizon were included. Using individual-level FT data from April 2015 to March 2016, incremental cost-effectiveness ratios (ICERs) (with 95% confidence interval) were estimated using regression. Subgroup analysis was completed for patients entering FT directly from inpatient rehabilitation and acute stroke care. Uncertainty was assessed using a cost-effectiveness acceptability curve with a range of willingness-to-pay values ($0–1000 per inpatient day saved). ICER (95% confidence interval) estimate for patients entering FT from inpatient rehabilitation was $404 ($270–620) per inpatient day saved. ICER estimate for direct from acute care admissions was $37 ($20–55) per day saved. At willingness-to-pay of $698 (cost of one alternate level of care day in acute care awaiting rehabilitation), the probability of FT being cost-effective was 99.2 and 100% for patients from inpatient rehabilitation and acute stroke care, respectively. From a single healthcare payer perspective, FT is a cost-effective method of providing appropriate rehabilitation intensity for stroke patients early on, and likely to provide savings to the healthcare system upstream through fewer days awaiting rehabilitation admission. *Alan K.H. Tam and Stephen Mac contributed equally to this study. Correspondence to Alan Tam, MD, 10-107, 550 University Avenue, Toronto, Ontario, Canada M5G 2A2 Tel: +1 416 597 3422 x3865; fax: +1 416 597 7107; e-mail: alan.tam@uhn.ca Received October 17, 2018 Accepted October 20, 2018 Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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