Costs and Caregiver Consequences of Early Supported Discharge for Stroke Patients

Abstract

Background and Purpose-Early supported discharge (ESD) for stroke has been shown to yield outcomes similar to or better than those of conventional care, but there is less information on the impact on costs and on the caregiver. The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care. Methods-We conducted a randomized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home. Results-Acute-care costs incurred before randomization when patients were medically ready for discharge averaged $3251 per person. The costs for the balance of the acute-care stay, from randomization to discharge, were $1383 for the home group and $2220 for the usual care group. The average cost of providing the 4-week home intervention service was $943 per person. The total cost generated by persons assigned to the home group averaged $7784 per person, significantly lower than the $11 065 per person for those assigned to usual care. A large proportion of the cost differential between the 2 groups arose from readmissions, for which the usual care group generated costs more than quadruple those of the home intervention group. Conclusions-Providing

Cost-effectiveness of self-managed versus physician-managed oral anticoagulation therapy

“…After a major event, patients with mild disability underwent one year of rehabilitation at a cost of $2176. 34 For those with permanent disability, we estimated an average yearly cost of $33 532 for care. 35 Costs are summarized in online Appendix 2 (www.cmaj.ca/cgi/content/full/174 /13/1847/DC2).…”

A qualitative study exploring patients’ and carers’ experiences of Early Supported Discharge services after stroke

“…Some studies have reported significantly heightened stress 2 and poorer mental health in carers receiving Early Supported Discharge. Other studies have shown no adverse impact on the subjective well-being 4 of carers and reduced caregiver burden 7 for carers of stroke patients receiving Early Supported Discharge compared with conventional services. However, none of the aforementioned studies used qualitative methodology to allow patients and carers to describe their experiences in their own words.…”

A review of the cost of cardiovascular disease

“…Ten studies estimating the cost of stroke (12,(15)(16)(17)(18)(19)(20)(21)(22)(23), of which three were Canadian studies and two were European reviews, were identified and are summarized in Table 2. Canada: Based on various public and private sources, the direct cost of stroke in Ontario was calculated to be at 2.7% of the total direct health care expenditures of Ontario (15).…”

“…In a randomized controlled trial (22), a tailored home intervention was shown to significantly reduce caregiver time and save money compared with usual care following discharge of stroke patients requiring rehabilitation service and who had a caregiver at home. In this study, the three-month direct medical cost following discharge was calculated to be $9,017 per patient in the intervention group and $12,818 in the usual care group.…”