Cost of acute and sub-acute care for stroke patients.

BACKGROUND: Stroke is an important health problem that imposes socioeconomic burdens. OBJECTIVE: To explore provider costs and to examine predictive factors for cost of acute and sub-acute inpatient services for stroke patients. MATERIAL AND METHOD: The present study design was prevalence-based cost-of-illness with micro-costing approach. Subjects were 407 first episode stroke patients. Patient costs were prospectively recorded from July 2008 to March 2009. RESULTS: The average cost per admission was 32,372 Baht. The cost of acute phase was higher than that of sub-acute phase. Moreover; costs were significantly different among disability levels. Predictors of cost in acute phase included surgery, hemorrhagic pathology, and length of stay (adjusted R2 = 0.755; p < 0.001). Additional predictors of costs in sub-acute phase included initial Barthel index, gender, rehabilitation treatment, and the hospital (adjusted R = 0.748; p < 0.001). CONCLUSION: Cost of stroke was influenced by patient characteristics, pathology, treatments, and phases of care that should be considered in reimbursement system policy.

Economic Evaluation of Rehabilitation Services for Inpatients with Stroke in Thailand: A Prospective Cohort Study.

OBJECTIVE: Rehabilitation can restore function and prevent permanent disability in patients with stroke. There is, however, only one study on cost-effectiveness of rehabilitation in Thailand. Our objective was to evaluate the cost-utility of rehabilitation for inpatients with stroke under Thai settings. METHODS: This was a prospective observational cohort study with a 4-month follow-up in two regional hospitals. The sample consisted of 207 first-episode stroke inpatients divided into rehabilitation and unexposed groups. Rehabilitation services during the subacute and nonacute phase were the intervention of concern. Main outcomes were patient's Barthel index for functional status and the EuroQol five-dimensional questionnaire as utility scores. A microcosting approach was employed considering a societal perspective. Effectiveness was defined as the improvement in functional status and quality-adjusted life-year (QALY). We used a longitudinal logistic model and multiple regressions. Cost-effectiveness ratios per QALY gained were presented. A probabilistic sensitivity analysis was conducted to estimate the uncertainty range. RESULTS: Compared with the unexposed group, the Barthel index and QALY of patients with rehabilitation were significantly improved (P < 0.010). The incremental cost-effectiveness ratio of rehabilitation services for patients with stroke was 24,571 baht per QALY. Cost-effectiveness acceptability curves suggested that the rehabilitation services were likely to represent good value for money at the ceiling ratio of 70,000 baht per QALY (compared with the threshold of 1 time per-capita gross domestic product per QALY gain or 100,000 baht per QALY). CONCLUSION: The rehabilitation services for stroke survivors were cost-effective under the Thai health care setting.

Casemix classification payment for sub-acute and non-acute inpatient care, Thailand.

BACKGROUND: There is a need to develop other casemix classifications, apart from DRG for sub-acute and non-acute inpatient care payment mechanism in Thailand. OBJECTIVE: To develop a casemix classification for sub-acute and non-acute inpatient service. MATERIAL AND METHOD: The study began with developing a classification system, analyzing cost, assigning payment weights, and ended with testing the validity of this new casemix system. Coefficient of variation, reduction in variance, linear regression, and split-half cross-validation were employed. RESULTS: The casemix for sub-acute and non-acute inpatient services contained 98 groups. Two percent of them had a coefficient of variation of the cost of higher than 1.5. The reduction in variance of cost after the classification was 32%. Two classification variables (physical function and the rehabilitation impairment categories) were key determinants of the cost (adjusted R2 = 0.749, p = .001). Validity results of split-half cross-validation of sub-acute and non-acute inpatient service were high. CONCLUSION: The present study indicated that the casemix for sub-acute and non-acute inpatient services closely predicted the hospital resource use and should be further developed for payment of the inpatients sub-acute and non-acute phase.