Stroke: community-based rehabilitation was less expensive than conventional care.

Clinical bottom line (level 2b)

In patients who had a stroke, treatment with early discharge community-based rehabilitation was more cost-effective than conventional care.

Beech et al: Stroke 1999; 30: 729-735

Expires January 2003

The study

Cost analysis
Setting: inner-city teaching hospital, UK

Randomised trial of early discharge to community based therapy versus conventional care.

Viewpoint: health care system

Benefit assessment: cost of treatment per patient

Resources and costs: Employment costs were obtained from the local finance department, and a nurse staffing unit cost per day was calculated. Data on care of the elderly medical staff costs per day were obtained from the hospital finance department, as were unit costs for the diagnotic tests used by patients. Costs for outpatient physician contact were obtained from the local finance department, and costs per general practitioner contact and per contact with other community-based health and social services were extracted from a publication by Netton and Dennett (which stems from a project that derives national statistics for England and Wales). Staff costs were based on midpoints of the pay scale. All costs included an allowance for general overhead- 69% for hospital staff costs, and 23% in community-based staff.

Sensitivity analysis: Lowering the general overhead for in-hospital costs to 56%.

The evidence

intervention	cost
conventional care	GBP 7432
early discharge therapy	GBP 6800

Citation

Beech R, Rudd AG, Tillings K, et al: Economic consequences of early inpatient discharge to community-based rehabilitation for stroke in an inner-London teaching hospital. Stroke 1999; 30: 729-735

Contributor: Clare Wotton and Musab Hayatli, January 2000
Reviewer: Daniel Sontheimer

_{Clinical Question.}

_Patient	_stroke
_{Intervention or Exposure}	_{early discharge to community-based therapy}
_Comparison	_{conventional care}
_Outcome	_cost