Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Praha.
Department of Rehabilitation, Krajská zdravotní, a.s., Masaryk Hospital in Ústí nad Labem, Ústí nad Labem.
Int J Rehabil Res. 2020 Dec;43(4):376-382. doi: 10.1097/MRR.0000000000000440.
The purpose of this prospective study was to determine whether the cost and cost-effectiveness of early rehabilitation after stroke are associated with the degree of initial disability. The data for cost calculations were collected by the bottom-up (micro-costing) method alongside the standard inpatient care. The total sample included 87 patients who were transferred from acute care to early rehabilitation unit of three participating stroke centers at the median time poststroke of 11 days (range 4-69 days). The study was pragmatic so that all hospitals followed their standard therapeutic procedures. For each patient, the staff recorded each procedure and the associated time over the hospital stay. The cost and cost-effectiveness were compared between four disability categories. The average cost of the entire hospitalization was CZK 114 489 (EUR 4348) with the daily average of CZK 5103 (EUR 194). The cost was 2.4 times higher for the immobile category (CZK/EU: 167 530/6363) than the self-sufficient category (CZK/EUR: 68 825/2614), and the main driver of the increase was the cost of nursing. The motor status had a much greater influence than cognitive status. We conclude that the cost and cost-effectiveness of early rehabilitation after stroke are positively associated with the degree of the motor but not cognitive disability. To justify the cost of rehabilitation and monitor its effectiveness, it is recommended to systematically record the elements of care provided and perform functional assessments on admission and discharge.
本前瞻性研究旨在确定卒中后早期康复的成本和成本效益是否与初始残疾程度有关。成本计算数据是通过自下而上（微观成本）方法与标准住院护理同时收集的。总样本包括 87 名患者，他们在卒中后中位时间 11 天（范围 4-69 天）从急性护理病房转移到三个参与卒中中心的早期康复病房。该研究具有务实性，所有医院都遵循其标准治疗程序。对于每位患者，工作人员都记录了住院期间的每个程序及其相关时间。在四个残疾类别之间比较了成本和成本效益。整个住院治疗的平均费用为 114489 捷克克朗（4348 欧元），平均每天为 5103 捷克克朗（194 欧元）。不能活动类别的费用比自理类别的费用高 2.4 倍（捷克克朗/欧元：167530/6363），主要驱动因素是护理费用。运动状态比认知状态的影响大得多。我们得出结论，卒中后早期康复的成本和成本效益与运动残疾程度呈正相关，而与认知残疾程度无关。为了证明康复的成本合理性并监测其效果，建议系统地记录所提供护理的要素，并在入院和出院时进行功能评估。
