Cost-effectiveness Analysis of Different Physical Therapy Models for Stroke Patients within Six Months After Discharged from Hospitals

• Main Authors: Mei-Lan Chang, 張梅蘭
• Other Authors: Yue-Chune Lee
• Format: Others
• Language: zh-TW
• Published: 2003
• Online Access: http://ndltd.ncl.edu.tw/handle/51374328375394255118

碩士 === 國立陽明大學 === 衛生福利研究所 === 91 === Cerebral vascular disease is the second leading causes of death in Taiwan . Most stroke survivors need physical therapy to improve their functions. However, in order to control length of stay, patients were usually early discharged by the hospitals when their physical function was still poor. Therefore, the provision of either home or outpatient physical therapy become very important. In 1998, a home physical therapy program was launched by Taipei city. This provided us an opportunity to compare the costs and the effectiveness of different physical therapy models for stroke patients. The purpose of this study was to compare the cost-effectiveness of different physical therapy models for the newly discharged stroke patients from a societal point of view. A mailing questionnaire was developed and send to patients to collect basic and clinical characteristics, functional status at and 6 month after discharge, costs within 6 months after discharge, life satisfaction and access barriers. A total of 897 patients were recruited from 3 hospitals and Taipei Society of Physical Therapy from Jan. 1 2001 to June 30, 2002. A maximal of 3 phone calls were conducted to increase the response rate. 166 cases responded, yielded a respondent rate of 25.3%. Among the respondents, 39 were in control group (no physical therapy model, NPTM), 32 cases in home physical therapy model (HPTM), 74 cases in outpatient physical therapy model (OPTM) and 21 cases in home and outpatient mixed physical therapy model (MPTM). The major results of this study were as follows: 1. The extent of the physical functional improvement of HPTM, OPTM and MPTM were better than that of control group. The likelihood of improvement of MPTM is 6.4 times of the control group. 2. Satisfaction on quality of life was significantly affected by the physical function at 6 month after discharged from hospital (p=0.025). Total satisfactory score was significantly improved at 6 month after discharged in MPTM. The total economic cost, including direct and indirect costs, of each stroke patient was NT$573652.5 within 6 months after discharge. While the cost of MPTM was the highest (NT$654757.4), the cost of control group was the lowest (NT$5117777.5); HPTM (NT$592506.2) and OPTM (NT$575093.1) were in between. 3. The total cost of each stroke patient paid by National Health Insurance was NT$77078.7 on the average. While the MPTM was the lowest (NT$64005.0) and the OPTM (NT$85165.8) the highest; HPTM (NT$79621.7) and control groups (NT$66687) in between. 4. The lowest ratio of cost-effectiveness of four models was the OPTM (86851.0), MPTM (88708.4) ranked the second. The lowest incremental cost-effectiveness ratio was also the OPTM (11915.2). However, sensitivity analysis indicated that the lowest ratio of cost-effectiveness changed to the MPTM when hospital cost was assumed to increase by 50% more than what was used in the current analysis. 5. The access barrier analysis showed that MPTM and OPTM were less likely to be affected by poor mobility of the patient, bad weather, slow functional improvement, poor communication, inconvenient transportation and bad home construction than either HPTM or control group. In conclusion, we highly suggest that stroke patients should receive physical therapy immediately after discharged from hospital. To select the best physical therapy model, accessibility and patients’ need should be taken into account, to achieve the best outcome.