Morii Yasuhiro, Abiko Kagari, Osanai Toshiya, Takami Jiro, Tanikawa Takumi, Fujiwara Kensuke, Houkin Kiyohiro, Ogasawara Katsuhiko
Center for Outcomes Research and Economic Evaluation for Health, National Institute of Public Health, 2-3-6 Minami, Wako, Saitama, Japan.
Faculty of Health Sciences, Hokkaido University, N12-W5, Kita-Ku, Sapporo, Hokkaido, Japan.
Cost Eff Resour Alloc. 2023 Feb 1;21(1):12. doi: 10.1186/s12962-023-00421-3.
Rehabilitation is an essential medical service for patients who have suffered acute stroke. Although the effectiveness of 7-days-per-week rehabilitation schedule has been studied in comparison with 5- or 6-days-per-week rehabilitation schedule, its cost-effectiveness has not been analyzed. In this research, to help formulate more cost-effective medical treatments for acute stroke patients, we analyzed the cost-effectiveness of 7-days-per-week rehabilitation for acute stroke from public health payer's perspective, and public healthcare and long-term care payer's perspective in Japan.
Cost-effectiveness of 7-days-per-week rehabilitation for acute stroke patients was analyzed based on the result from a previous study using a Japanese database examining the efficacy of 7-days-per-week rehabilitation. Cost utility analysis was conducted by comparing 7-days-per-week rehabilitation with 5- or 6-days-per-week rehabilitation, with its main outcome incremental cost-effectiveness ratio (ICER) calculated by dividing estimated incremental medical and long-term care costs by incremental quality-adjusted life years (QALY). The costs were estimated using the Japanese fee table and from published sources. The time horizon was 5 years, and Markov modeling was used for the analysis.
The ICER was $6339/QALY from public health payer's perspective, lower than 5,000,000 Yen/QALY (approximately US$37,913), which was the willingness-to-pay used for the cost-effectiveness evaluation in Japan. The 7-day-per-week rehabilitation was dominant from public healthcare and long-term care payer's perspective. The result of sensitivity analysis confirmed the results.
The results indicated that 7-days-per-week rehabilitation for acute stroke rehabilitation was likely to be cost-effective.
康复治疗是急性中风患者必不可少的医疗服务。尽管已经对每周7天康复计划与每周5天或6天康复计划的有效性进行了比较研究，但其成本效益尚未得到分析。在本研究中，为了帮助制定更具成本效益的急性中风患者治疗方案，我们从公共卫生支付者的角度以及日本公共医疗保健和长期护理支付者的角度，分析了急性中风每周7天康复的成本效益。
基于先前一项使用日本数据库研究每周7天康复疗效的研究结果，分析急性中风患者每周7天康复的成本效益。通过比较每周7天康复与每周5天或6天康复进行成本效用分析，其主要结果增量成本效益比（ICER）通过将估计的增量医疗和长期护理成本除以增量质量调整生命年（QALY）来计算。成本使用日本收费表和已发表资料进行估算。时间范围为5年，采用马尔可夫模型进行分析。
从公共卫生支付者的角度来看，ICER为6339美元/QALY，低于5000000日元/QALY（约合37913美元），这是日本用于成本效益评估的支付意愿。从公共医疗保健和长期护理支付者的角度来看，每周7天康复占主导地位。敏感性分析结果证实了这一结果。
结果表明，急性中风康复每周7天的康复治疗可能具有成本效益。
