Chan B
Ont Health Technol Assess Ser. 2015 Mar 1;15(7):1-43. eCollection 2015.
Functional improvements have been seen in stroke patients who have received an increased intensity of physiotherapy. This requires additional costs in the form of increased physiotherapist time.
The objective of this economic analysis is to determine the cost-effectiveness of increasing the intensity of physiotherapy (duration and/or frequency) during inpatient rehabilitation after stroke, from the perspective of the Ontario Ministry of Health and Long-term Care.
The inputs for our economic evaluation were extracted from articles published in peer-reviewed journals and from reports from government sources or the Canadian Stroke Network. Where published data were not available, we sought expert opinion and used inputs based on the experts' estimates.
The primary outcome we considered was cost per quality-adjusted life-year (QALY). We also evaluated functional strength training because of its similarities to physiotherapy. We used a 2-state Markov model to evaluate the cost-effectiveness of functional strength training and increased physiotherapy intensity for stroke inpatient rehabilitation. The model had a lifetime timeframe with a 5% annual discount rate. We then used sensitivity analyses to evaluate uncertainty in the model inputs.
We found that functional strength training and higher-intensity physiotherapy resulted in lower costs and improved outcomes over a lifetime. However, our sensitivity analyses revealed high levels of uncertainty in the model inputs, and therefore in the results.
There is a high level of uncertainty in this analysis due to the uncertainty in model inputs, with some of the major inputs based on expert panel consensus or expert opinion. In addition, the utility outcomes were based on a clinical study conducted in the United Kingdom (i.e., 1 study only, and not in an Ontario or Canadian setting).
Functional strength training and higher-intensity physiotherapy may result in lower costs and improved health outcomes. However, these results should be interpreted with caution.
接受强化物理治疗的中风患者已出现功能改善。这需要以增加物理治疗师工作时间的形式产生额外成本。
本经济分析的目的是从安大略省卫生和长期护理部的角度，确定中风后住院康复期间增加物理治疗强度（时长和/或频率）的成本效益。
我们经济评估的输入数据摘自同行评审期刊发表的文章以及政府来源或加拿大中风网络的报告。在没有公开数据的情况下，我们征求了专家意见，并使用基于专家估计的输入数据。
我们考虑的主要结果是每质量调整生命年（QALY）的成本。由于功能强化训练与物理治疗相似，我们也对其进行了评估。我们使用双状态马尔可夫模型来评估功能强化训练和增加物理治疗强度对中风住院康复的成本效益。该模型的时间范围为终身，年贴现率为5%。然后，我们使用敏感性分析来评估模型输入中的不确定性。
我们发现，功能强化训练和高强度物理治疗在一生中可降低成本并改善结果。然而，我们的敏感性分析显示模型输入存在高度不确定性，因此结果也存在不确定性。
由于模型输入的不确定性，本分析存在高度不确定性，一些主要输入基于专家小组共识或专家意见。此外，效用结果基于在英国进行的一项临床研究（即仅一项研究，而非在安大略省或加拿大环境中进行）。
功能强化训练和高强度物理治疗可能会降低成本并改善健康结果。然而，这些结果应谨慎解读。
