Evaluating stroke early supported discharge using cost-consequence analysis

Area of Science:

• Health Services Research
• Rehabilitation Medicine
• Health Economics

Background:

• Early Supported Discharge (ESD) is a crucial multidisciplinary intervention for stroke survivors, enabling hospital discharge and home-based specialist rehabilitation.
• Evaluating the cost-effectiveness of ESD services across diverse geographical settings is essential for optimizing resource allocation and patient care.
• Cost-Consequence Analysis (CCA) offers a framework to assess both the financial implications and outcome achievements of healthcare interventions.

Purpose of the Study:

• To conduct a Cost-Consequence Analysis (CCA) of different stroke Early Supported Discharge (ESD) services operating in varied geographical locations.
• To identify the primary cost drivers and outcome measures associated with ESD provision in rural versus urban settings.

Main Methods:

• A Cost-Consequence Analysis (CCA) was performed on data from six purposively selected ESD services in England (rural and urban).
• Cost data encompassed direct service provision, overheads, and staff travel expenses.
• Consequence data focused on service adherence to an expert-defined consensus on ESD service specification.

Main Results:

• Higher per-patient service costs were observed in the most rural ESD services.
• Staff costs represented the largest component of ESD service expenditures.
• Increased per-patient costs demonstrated a positive association with greater adherence to the evidence-based ESD service specification.

Conclusions:

• Rural ESD services are associated with elevated per-patient costs, which are linked to enhanced adherence to established ESD service standards.
• Additional financial resources are likely necessary for rural ESD services to fully meet evidence-based criteria and optimize stroke rehabilitation outcomes.
• The findings underscore the importance of adequate funding for ESD services, particularly in rural areas, to ensure high-quality, evidence-based care for stroke survivors.