J Med Assoc Thai 2010; 93 (12):262

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Cost-Effectiveness Analysis of Home Rehabilitation Programs for Thai Stroke Patients
Sritipsukho P Mail, Riewpaiboon A , Chaiyawat P , Kulkantrakorn K

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.

Keywords: Cost-effectiveness analysis, Home rehabilitation program, Stroke

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