Stroke rehabilitation: a cost-effectiveness analysis of a placement scheme

The Leeds Stroke Rehabilitation Placement Scheme (SRPS) provides short-term intensive support for vulnerable stroke patients on discharge from hospital. A previous study at one year post stroke established the benefits of this community support, demonstrating that patients involved in the scheme were more likely to maintain their three-month post stroke functional ability than patients discharged directly at home, as is conventional. Given the scarcity of resources, however, it is important to demonstrate not only the effectiveness of an intervention but also the cost-effectiveness, in order to ensure that resources are allocated efficiently. The aim of this study was to combine the previously reported effectiveness data with newly gathered cost information, to carry out a cost-effectiveness analysis of the SRPS. The results show that the SRPS attained a unit increase in functional ability, as given by the Barthel Activities of Daily Living Index, at lower cost (£586.85) than the alternative of discharging patients directly home (£5859.48). Although methodological problems and limitations in the data allow only tentative conclusions to be made, the study does highlight the practical problems encountered in the field of cost-effectiveness analysis and makes a number of recommendations to guide future evaluations of stroke rehabilitation services.