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Cost-effectiveness of a high-intensity rapid access outpatient stroke rehabilitation program

Tam, Alana,b,c,*; Mac, Stephenb,d,*; Isaranuwatchai, Wanrudeeb,e; Bayley, Marka,b,c

International Journal of Rehabilitation Research: March 2019 - Volume 42 - Issue 1 - p 56–62
doi: 10.1097/MRR.0000000000000327
Original articles

A common strategy to improve cost-effectiveness in healthcare is to offer outpatient care instead of in-hospital care. Toronto Rehabilitation Institute developed an outpatient high-intensity fast-track (FT) stroke rehabilitation program aimed at discharging inpatient stroke rehabilitation patients earlier or bypassing inpatient rehabilitation altogether. This cost-effectiveness analysis compares FT rehabilitation within 1 week of discharge with no FT in a single healthcare payer system. Patient costs and outcomes over a 12-week time horizon were included. Using individual-level FT data from April 2015 to March 2016, incremental cost-effectiveness ratios (ICERs) (with 95% confidence interval) were estimated using regression. Subgroup analysis was completed for patients entering FT directly from inpatient rehabilitation and acute stroke care. Uncertainty was assessed using a cost-effectiveness acceptability curve with a range of willingness-to-pay values ($0–1000 per inpatient day saved). ICER (95% confidence interval) estimate for patients entering FT from inpatient rehabilitation was $404 ($270–620) per inpatient day saved. ICER estimate for direct from acute care admissions was $37 ($20–55) per day saved. At willingness-to-pay of $698 (cost of one alternate level of care day in acute care awaiting rehabilitation), the probability of FT being cost-effective was 99.2 and 100% for patients from inpatient rehabilitation and acute stroke care, respectively. From a single healthcare payer perspective, FT is a cost-effective method of providing appropriate rehabilitation intensity for stroke patients early on, and likely to provide savings to the healthcare system upstream through fewer days awaiting rehabilitation admission.

aDepartment of Medicine, Division of Physical Medicine and Rehabilitation

bInstitute of Health Policy Management and Evaluation, University of Toronto

cToronto Rehabilitation Institute

dToronto Health Economics and Technology Assessment Collaborative, University Health Network

eLi Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada

*Alan Tam and Stephen Mac contributed equally to this study.

Correspondence to Alan Tam, MD, 10-107, 550 University Avenue, Toronto, Ontario, Canada M5G 2A2 Tel: +1 416 597 3422 x3865; fax: +1 416 597 7107; e-mail:

Received October 17, 2018

Accepted October 20, 2018

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