Khiaocharoen Orathai, Pannarunothai Supasit, Riewpaiboon Wachara, Ingsrisawang Lily, Teerawattananon Yot
Health Systems and Policy Programme, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand.
Faculty of Medicine, Centre for Health Equity Monitoring, Naresuan University, Phitsanulok, Thailand.
Value Health Reg Issues. 2012 May;1(1):29-35. doi: 10.1016/j.vhri.2012.03.021. Epub 2012 May 25.
Rehabilitation can restore function and prevent permanent disability in patients with stroke. There is, however, only one study on cost-effectiveness of rehabilitation in Thailand. Our objective was to evaluate the cost-utility of rehabilitation for inpatients with stroke under Thai settings.
This was a prospective observational cohort study with a 4-month follow-up in two regional hospitals. The sample consisted of 207 first-episode stroke inpatients divided into rehabilitation and unexposed groups. Rehabilitation services during the subacute and nonacute phase were the intervention of concern. Main outcomes were patient's Barthel index for functional status and the EuroQol five-dimensional questionnaire as utility scores. A microcosting approach was employed considering a societal perspective. Effectiveness was defined as the improvement in functional status and quality-adjusted life-year (QALY). We used a longitudinal logistic model and multiple regressions. Cost-effectiveness ratios per QALY gained were presented. A probabilistic sensitivity analysis was conducted to estimate the uncertainty range.
Compared with the unexposed group, the Barthel index and QALY of patients with rehabilitation were significantly improved (P < 0.010). The incremental cost-effectiveness ratio of rehabilitation services for patients with stroke was 24,571 baht per QALY. Cost-effectiveness acceptability curves suggested that the rehabilitation services were likely to represent good value for money at the ceiling ratio of 70,000 baht per QALY (compared with the threshold of 1 time per-capita gross domestic product per QALY gain or 100,000 baht per QALY).
The rehabilitation services for stroke survivors were cost-effective under the Thai health care setting.
康复治疗可恢复中风患者的功能并预防永久性残疾。然而，泰国仅有一项关于康复治疗成本效益的研究。我们的目的是评估泰国环境下中风住院患者康复治疗的成本效用。
这是一项前瞻性观察队列研究，在两家地区医院进行了为期4个月的随访。样本包括207例首次发作的中风住院患者，分为康复组和未接受康复组。亚急性期和非急性期的康复服务是关注的干预措施。主要结局是患者功能状态的巴氏指数和欧洲五维健康量表作为效用得分。采用微观成本核算方法，考虑社会视角。有效性定义为功能状态和质量调整生命年（QALY）的改善。我们使用纵向逻辑模型和多元回归分析。呈现了每获得一个QALY的成本效益比。进行了概率敏感性分析以估计不确定性范围。
与未接受康复组相比，接受康复治疗患者的巴氏指数和QALY显著改善（P < 0.010）。中风患者康复服务的增量成本效益比为每QALY 24,571泰铢。成本效益可接受性曲线表明，康复服务在每QALY 70,000泰铢的上限比率下可能具有良好的性价比（与每获得一个QALY 1倍人均国内生产总值或每QALY 100,000泰铢的阈值相比）。
在泰国医疗保健环境下，中风幸存者的康复服务具有成本效益。
