Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients.

BACKGROUND The individual home rehabilitation program for ischemic stroke patients was conducted in a Thai healthcare setting. The program demonstrated that it was statistically significantly more effective than the conventional method. However for policy makers to adopt this program, the question of cost-effectiveness must be answered. OBJECTIVE To compare the costs and effects of a home rehabilitation program versus conventional hospital care for ischemic stroke patients in Thailand. MATERIAL AND METHOD Cost-effectiveness analysis was conducted alongside a clinical trial. An open-label randomized control trial was conducted to explore the efficacy of a home rehabilitation program for acute stroke care for three months after hospital discharge. The Barthel Index and Modified Rankin Scale were used to evaluate the outcome measures. Success was defined as improvement by at least one level of the outcome scales. An incremental cost-effectiveness ratio, including sensitivity analysis, was presented. RESULTS Fifty-eight patients were included in the study. Patients were randomly assigned to the study and control groups (28 and 30, respectively). The cost and number of successful cases in the study group were higher than those of the control group. The incremental cost-effectiveness ratio (ICER) was lowest--13,644 Thai Baht (THB)--regarding the Modified Rankin Scale measurement. For patients achieving mild disability and no disability based on the Barthel Index, the ICERs were 14,212 THB and 24,364 THB, respectively. Sensitivity analyses regarding variations in number of patients and cost of home visits demonstrated more cost-effectiveness than the base case. CONCLUSION Providing a home rehabilitation program with higher cost resulted in a greater number of patients avoiding disability than via conventional hospital care. The hospital had to pay approximately 24,000 THB for each additional disability-avoided patient when switching from conventional hospital care to a home rehabilitation program. This was assumed to be cost-effective when compared to per capita gross domestic product.