Tam Alan, Mac Stephen, Isaranuwatchai Wanrudee, Bayley Mark
Department of Medicine, Division of Physical Medicine and Rehabilitation.
Institute of Health Policy Management and Evaluation, University of Toronto.
Int J Rehabil Res. 2019 Mar;42(1):56-62. doi: 10.1097/MRR.0000000000000327.
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.
提高医疗保健成本效益的一个常见策略是提供门诊护理而非住院护理。多伦多康复研究所制定了一项门诊高强度快速通道（FT）中风康复计划，旨在让中风康复住院患者更早出院，或完全绕过住院康复。这项成本效益分析比较了在单一医疗支付系统中，出院后1周内进行FT康复与不进行FT康复的情况。纳入了12周时间范围内的患者成本和结果。利用2015年4月至2016年3月的个体层面FT数据，通过回归估计增量成本效益比（ICERs）（95%置信区间）。对直接从住院康复和急性中风护理进入FT的患者进行了亚组分析。使用成本效益可接受性曲线和一系列支付意愿值（每节省一天住院费用0 - 1000美元）评估不确定性。从住院康复进入FT的患者的ICER（95%置信区间）估计为每节省一天住院费用404美元（270 - 620美元）。直接从急性护理入院患者的ICER估计为每天节省37美元（20 - 55美元）。在支付意愿为698美元（急性护理中等待康复的另一种护理水平一天的费用）时，FT具有成本效益的概率分别为99.2%和100%，适用于来自住院康复和急性中风护理的患者。从单一医疗支付方的角度来看，FT是一种在早期为中风患者提供适当康复强度的具有成本效益的方法，并且可能通过减少等待康复入院的天数为上游医疗系统节省费用。
