Cent Eur J Public Health 2021, 29(2):153-158 | DOI: 10.21101/cejph.a6111

Cost analysis of early rehabilitation after stroke in comprehensive cerebrovascular centres in the Czech Republic

Yvona Angerová1, Pavel Maršálek2, Irina Chmelová3, 4, Tereza Gueye5, Miroslav Barták6, Štěpán Uherek7, Jan Bříza8, Vladimír Rogalewicz1
1 Department of Rehabilitation Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
2 Rehabilitation Department, Masaryk Hospital, Ústí nad Labem, Czech Republic
3 Clinic of Rehabilitation and Physical Medicine, University Hospital Ostrava, Ostrava, Czech Republic
4 Department of Rehabilitation, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
5 Stroke Unit Rehabilitation Department, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
6 Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
7 Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
8 First Department of Surgery, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic

Objectives: The paper analyses real-world data on cost of treatment in patients after stroke hospitalized in early rehabilitation units within comprehensive stroke centres in the Czech Republic. This is the first study of the kind in the Czech Republic, while such information is extremely rare worldwide. Stroke treatment witnessed a dramatic development in the last years, when the main progress was due to establishment of specialized (comprehensive) stroke units incorporating also early rehabilitation. There is a general agreement among clinicians that early rehabilitation is beneficial for patients after stroke.

Methods: Costs of early rehabilitation after stroke were calculated by the micro-costing method alongside a pragmatic study in three Czech hospitals. Patients were transferred to specialized early rehabilitation units usually on 7th to 14th day after stroke onset and received four hours of interprofessional rehabilitation per day.

Results: The analysis of data collected during the prospective observational research of 87 patients proved significant differences between patients. The average costs of hospitalization were determined to be CZK 5,104 (EUR 194) per one day of intensive rehabilitation in seriously affected patients early after stroke. These costs differed significantly between hospitals (p-value < 0.001); the structure of direct costs was quite stable, though. About 60% of these costs were due to nursing and overhead, while no more than 15% were consumed by therapists.

Conclusions: The treatment of patients after stroke in specialized stroke units proved to be beneficial for the patients increasing the number of those re-integrated in family and community life.

Keywords: stroke, early rehabilitation, comprehensive stroke centre, costs, real-world data

Received: January 24, 2020; Revised: April 1, 2021; Accepted: April 1, 2021; Published: June 30, 2021  Show citation

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Angerová Y, Maršálek P, Chmelová I, Gueye T, Barták M, Uherek Š, et al.. Cost analysis of early rehabilitation after stroke in comprehensive cerebrovascular centres in the Czech Republic. Cent Eur J Public Health. 2021;29(2):153-158. doi: 10.21101/cejph.a6111. PubMed PMID: 34245556.
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    References

    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383(9913):245-55. Go to original source... Go to PubMed...
    2. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913-24. Go to original source... Go to PubMed...
    3. Institute of Health Information and Statistics of the Czech Republic. Cerebrovascular diseases - hospitalized patients and deaths in the Czech Republic in 2003-2010. Aktuální informace [Internet]. 2012 Feb [cited 2021 Apr 1];(3):1-27. Available from: https://www.uzis.cz/sites/default/files/knihovna/03_12.pdf.
    4. Joo H, Wang GJ, Yee SL, Zhang P, Sleet D. Economic burden of informal caregiving associated with history of stroke and falls among older adults in the US. Am J Prev Med. 2017;53(6):S197-204. Go to original source... Go to PubMed...
    5. Xu XM, Vestesson E, Paley L, Desikan A, Wonderling D, Hoffman A, et al. The economic burden of stroke care in England, Wales and Northern Ireland: using a national stroke register to estimate and report patient-level health economic outcomes in stroke. Eur Stroke J. 2018;3(1):82-91. Go to original source... Go to PubMed...
    6. Snozzi P, Blank PR, Szucs TD. Stroke in Switzerland: social determinants of treatment access and cost of illness. J Stroke Cerebrovasc Dis. 2014;23(5):926-32. Go to original source... Go to PubMed...
    7. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49(3):e46-110. Go to original source... Go to PubMed...
    8. Škoda O, Herzig R, Mikulík R, Neumann J, Václavík D, Bar M, et al. Clinical Guideline for the Diagnostics and Treatment of Patients with Ischemic Stroke and Transitory Ischemic Attack - version 2016. Ces Slov Neurol Neurochir. 2016;79(3):351-63. (In Czech.) Go to original source...
    9. Hamann GF, Müller R, Alber B, Widder B. Treatment in acute stroke - stroke unit is mandatory. Neurol Psych Brain Res. 2016;22(2):105-9. Go to original source...
    10. Ministry of Health of the Czech Republic. Care of patients with cerebrovascular disease in the Czech Republic. Věstník MZ ČR. 2010;2010(2):2-13. (In Czech.)
    11. Ministry of Health of the Czech Republic. List of highly specialized centers for the care of patients after acute stroke. Věstník MZ ČR. 2015;2015(11):52-6. (In Czech.)
    12. Zhai S, Gardiner F, Neeman T, Jones B, Gawarikar Y. The cost-effectiveness of a stroke unit in providing enhanced patient outcomes in an Australian teaching hospital. J Stroke Cerebrovasc Dis. 2017;26(10):2362-8. Go to original source... Go to PubMed...
    13. Langhorne P, Wu O, Rodgers H, Ashburn A, Bernhardt J. A Very Early Rehabilitation Trial after stroke (AVERT): a Phase III, multicentre, randomised controlled trial. Health Technol Assess. 2017;21(54):1-120. Go to original source... Go to PubMed...
    14. Bernhardt J, Langhorne P, Lindley RI, Thrift AG, Ellery F, Collier J, et al. Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial. Lancet. 2015;386(9988):46-55. Go to original source... Go to PubMed...
    15. Murphy TH, Corbett D. Plasticity during stroke recovery: from synapse to behaviour. Natur Rev Neurosci. 2009;10(12):861-72. Go to original source... Go to PubMed...
    16. Krakauer JW, Carmichael ST, Corbett D, Wittenberg GF. Getting neurorehabilitation right: what can be learned from animal models? Neurorehabil Neural Repair. 2012;26(8):923-31. Go to original source... Go to PubMed...
    17. Hsieh CY, Huang HC, Wu DP, Li CY, Chiu MJ, Sung SF. Effect of rehabilitation intensity on mortality risk after stroke. Arch Phys Med Rehabil. 2018;99(6):1042-8. Go to original source... Go to PubMed...
    18. Enderby P, Pandyan A, Bowen A, Hearnden D, Ashburn A, Conroy P, et al. Accessing rehabilitation after stroke - a guessing game? Disabil Rehabil. 2017;39(7):709-13. Go to original source... Go to PubMed...
    19. Hacke W, Ringleb PA, Bousser M-G, Ford G, Bath P, Brainin M, et al. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008 - The European Stroke Organisation (ESO) Executive Committee and the ESO Writing Committee. Cerebrovasc Dis. 2008;25(5):457-507. Go to original source... Go to PubMed...
    20. Quinn TJ, Paolucci S, Sunnerhagen KS, Sivenius J, Walker MF, Toni D, et al. Evidence-based stroke rehabilitation: an expanded guidance document from the European Stroke Organisation (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008. J Rehabil Med. 2009;41(2):99-111. Go to original source... Go to PubMed...
    21. Lynch E, Hillier S, Cadilhac D. When should physical rehabilitation commence after stroke: a systematic review. Int J Stroke. 2014;9(4):468-78. Go to original source... Go to PubMed...
    22. Miranda Rocha AR, Martinez BP, Maldaner da Silva VZ, Forgiarini Junior LA. Early mobilization: Why, what for and how? Med Intensiva. 2017;41(7):429-36. Go to original source... Go to PubMed...
    23. Li ZY, Zhang XM, Wang K, Wen J. Effects of early mobilization after acute stroke: a meta-analysis of randomized control trials. J Stroke Cerebrovasc Dis. 2018;27(5):1326-37. Go to original source... Go to PubMed...
    24. Nelson ML, McKellar KA, Munce S, Kelloway L, Hans PK, Fortin M, et al. Addressing the evidence gap in stroke rehabilitation for complex patients: a preliminary research agenda. Arch Phys Med Rehabil. 2018;99(6):1232-41. Go to original source... Go to PubMed...
    25. Yagi M, Yasunaga H, Matsui H, Morita K, Fushimi K, Fujimoto M, et al. Impact of rehabilitation on outcomes in patients with ischemic stroke: a nationwide retrospective cohort study in Japan. Stroke. 2017;48(3):740-6. Go to original source... Go to PubMed...
    26. Institute of Health Information and Statistics of the Czech Republic. Healtcare in the Czech Republic: personnel capacities and remuneration 2018 [Internet]. Prague: Institute of Health Information and Statistics of the Czech Republic; 2019 [cited 2021 Apr 1]. Available from: https://www.uzis.cz/res/f/008281/nzis-rep-2019-e04-personalni-kapacity-odmenovani-2018.pdf. (In Czech.)
    27. Bernhardt J, Dewey H, Thrift A, Collier J, Donnan G. A very early rehabilitation trial for stroke (AVERT) phase II safety and feasibility. Stroke. 2008;39(2):390-6. Go to original source... Go to PubMed...
    28. Tay-Teo K, Moodie M, Bernhardt J, Thrift AG, Collier J, Donnan G, et al. Economic Evaluation alongside a Phase II, Multi-Centre, Randomised Controlled Trial of Very Early Rehabilitation after Stroke (AVERT). Cerebrovasc Dis. 2008;26(5):475-81. Go to original source... Go to PubMed...
    29. Sheppard L, Dewey H, Bernhardt J, Collier JM, Ellery F, Churilov L, et al. Economic Evaluation Plan (EEP) for A Very Early Rehabilitation Trial (AVERT): an international trial to compare the costs and cost-effectiveness of commencing out of bed standing and walking training (very early mobilization) within 24h of stroke onset with usual stroke unit care. Int J Stroke. 2016;11(4):492-4. Go to original source... Go to PubMed...
    30. Angerova Y, Marsalek P, Chmelova I, Gueye T, Uherek S, Briza J, et al. Cost and cost-effectiveness of early inpatient rehabilitation after stroke varies with initial disability: the Czech Republic perspective. Int J Rehabil Res. 2020;43(4):376-82. Go to original source... Go to PubMed...
    31. Kratochvílová A, Rogalewicz V, Angerová Y, Gueye T, Maršálek P, Chmelová I, et al. Early rehabilitation after stroke in comprehensive cerebrovascular centres in the Czech Republic: a comparison of three stroke units. Kontakt. Ahead of print. doi: 10.32725/kont.2021.013. Go to original source...
    32. Gao L, Sheppard L, Wu O, Churilov L, Mohebbi M, Collier J, et al. Economic evaluation of a phase III international randomised controlled trial of very early mobilisation after stroke (AVERT). BMJ Open. 2019;9(5):e026230. doi: 10.1136/bmjopen-2018-026230. Go to original source... Go to PubMed...
    33. Lahiry S, Levi C, Kim J, Cadilhac DA, Searles A. Economic evaluation of a pre-hospital protocol for patients with suspected acute stroke. Front Public Health. 2018;6:43. doi: 10.3389/fpubh.2018.00043. Go to original source... Go to PubMed...

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