Economic Evaluation of Home-Based Stroke Care – A systematic review

Abstract

Background: The Global Burden of Disease (GBD) of 2019 ranked stroke, as both the second-leading cause of death and the third-leading cause of death and disability worldwide. As the burden of stroke has risen the past three decades, stroke has emerged as one of the current greatest public health issues worldwide of growing importance. During the past 40 years, healthcare expenditure has increased dramatically throughout the world. Home-based rehabilitation has the protentional to be an beneficial alternative to the conventional existing hospital-and institution-based rehabilitation programmes in the healthcare sector. Home-based rehabilitation for stroke has shown to have a significant effect and a clinical impact when compared to both hospital-based and institution-based rehabilitation. Objectives: The objective was to conduct a systematic review on the research question: Is home-based rehabilitation cost-effective compared to conventional rehabilitation in adult stroke patients? Method: MEDLINE, EMBASE, CINAHL, Web of Science and Scopus was searched in February 2023, reference list included publications and relevant systematic reviews to were screened for eligibility. Study selection, data extraction and assessment of methodological quality was carried out by one independent author. Outcome data were synthesized narratively due to heterogeneity in the outcomes. Results: Five full economic evaluations were included in this review. Narrative synthesis showed that all of the included studies found home-based rehabilitation to be a more cost-effective option for stroke patients based on health outcomes, such as Barthel index, mRS index, quality of life, mortality and hospitalization. The overall methodological quality in the included EEs was high/ good based on Drummonds 10 checklist and the QHES- instrument. Results of sensitivity analysis in the studies, also demonstrated results in favor of home-based rehabilitation. Conclusions: Due, to the limitations in this systematic review further research is needed according to the context of each country and based on clinical trials reporting outcomes that can improve the quality of evidence and give implication for future policy. If the cost-effectiveness of home-based rehabilitation suggested in this review is supplemented with further knowledge supporting these results, these findings could be an important contributor to policy makers and the current knowledge regarding stroke-rehabilitation.