Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients

Background: The individual home rehabilitation program for ischemic stroke patients was conducted in a Thai healthcare setting. The program demonstrated that it was statistically significantly more effective than the conventional method. However for policy makers to adopt this program, the question...

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Main Authors: Paskorn Sritipsukh, Arthorn Riewpaiboo, Pakaratee Chaiyawa, Kongkiat Kulkantrakor
Other Authors: Thammasat University
Format: Article
Published: 2018
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Online Access:https://repository.li.mahidol.ac.th/handle/123456789/29363
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spelling th-mahidol.293632018-09-24T16:14:05Z Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients Paskorn Sritipsukh Arthorn Riewpaiboo Pakaratee Chaiyawa Kongkiat Kulkantrakor Thammasat University Mahidol University Medicine Background: The individual home rehabilitation program for ischemic stroke patients was conducted in a Thai healthcare setting. The program demonstrated that it was statistically significantly more effective than the conventional method. However for policy makers to adopt this program, the question of cost-effectiveness must be answered. Objective: To compare the costs and effects of a home rehabilitation program versus conventional hospital care for ischemic stroke patients in Thailand. Material and Method: Cost-effectiveness analysis was conducted alongside a clinical trial. An open-label randomized control trial was conducted to explore the efficacy of a home rehabilitation program for acute stroke care for three months after hospital discharge. The Barthel Index and Modified Rankin Scale were used to evaluate the outcome measures. Success was defined as improvement by at least one level of the outcome scales. An incremental cost-effectiveness ratio, including sensitivity analysis, was presented. Results: Fifty-eight patients were included in the study. Patients were randomly assigned to the study and control groups (28 and 30, respectively). The cost and number of successful cases in the study group were higher than those of the control group. The incremental cost-effectiveness ratio (ICER) was lowest-13,644 Thai Baht (THB)-regarding the Modified Rankin Scale measurement. For patients achieving mild disability and no disability based on the Barthel Index, the ICERs were 14,212 THB and 24,364 THB, respectively. Sensitivity analyses regarding variations in number of patients and cost of home visits demonstrated more cost-effectiveness than the base case. Conclusion: Providing a home rehabilitation program with higher cost resulted in a greater number of patients avoiding disability than via conventional hospital care. The hospital had to pay approximately 24,000 THB for each additional disability-avoided patient when switching from conventional hospital care to a home rehabilitation program. This was assumed to be cost-effective when compared to per capita gross domestic product. 2018-09-24T09:14:05Z 2018-09-24T09:14:05Z 2010-12-01 Article Journal of the Medical Association of Thailand. Vol.93, No.SUPPL 7 (2010) 01252208 2-s2.0-79952494779 https://repository.li.mahidol.ac.th/handle/123456789/29363 Mahidol University SCOPUS https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=79952494779&origin=inward
institution Mahidol University
building Mahidol University Library
continent Asia
country Thailand
Thailand
content_provider Mahidol University Library
collection Mahidol University Institutional Repository
topic Medicine
spellingShingle Medicine
Paskorn Sritipsukh
Arthorn Riewpaiboo
Pakaratee Chaiyawa
Kongkiat Kulkantrakor
Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients
description Background: The individual home rehabilitation program for ischemic stroke patients was conducted in a Thai healthcare setting. The program demonstrated that it was statistically significantly more effective than the conventional method. However for policy makers to adopt this program, the question of cost-effectiveness must be answered. Objective: To compare the costs and effects of a home rehabilitation program versus conventional hospital care for ischemic stroke patients in Thailand. Material and Method: Cost-effectiveness analysis was conducted alongside a clinical trial. An open-label randomized control trial was conducted to explore the efficacy of a home rehabilitation program for acute stroke care for three months after hospital discharge. The Barthel Index and Modified Rankin Scale were used to evaluate the outcome measures. Success was defined as improvement by at least one level of the outcome scales. An incremental cost-effectiveness ratio, including sensitivity analysis, was presented. Results: Fifty-eight patients were included in the study. Patients were randomly assigned to the study and control groups (28 and 30, respectively). The cost and number of successful cases in the study group were higher than those of the control group. The incremental cost-effectiveness ratio (ICER) was lowest-13,644 Thai Baht (THB)-regarding the Modified Rankin Scale measurement. For patients achieving mild disability and no disability based on the Barthel Index, the ICERs were 14,212 THB and 24,364 THB, respectively. Sensitivity analyses regarding variations in number of patients and cost of home visits demonstrated more cost-effectiveness than the base case. Conclusion: Providing a home rehabilitation program with higher cost resulted in a greater number of patients avoiding disability than via conventional hospital care. The hospital had to pay approximately 24,000 THB for each additional disability-avoided patient when switching from conventional hospital care to a home rehabilitation program. This was assumed to be cost-effective when compared to per capita gross domestic product.
author2 Thammasat University
author_facet Thammasat University
Paskorn Sritipsukh
Arthorn Riewpaiboo
Pakaratee Chaiyawa
Kongkiat Kulkantrakor
format Article
author Paskorn Sritipsukh
Arthorn Riewpaiboo
Pakaratee Chaiyawa
Kongkiat Kulkantrakor
author_sort Paskorn Sritipsukh
title Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients
title_short Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients
title_full Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients
title_fullStr Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients
title_full_unstemmed Cost-effectiveness analysis of home rehabilitation programs for Thai stroke patients
title_sort cost-effectiveness analysis of home rehabilitation programs for thai stroke patients
publishDate 2018
url https://repository.li.mahidol.ac.th/handle/123456789/29363
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