Day hospital and home physiotherapy for stroke patients: a comparative cost-effectiveness study

The financial cost of stroke rehabilitation is considerable but few cost-effectiveness studies are available to guide clinical practice. The Bradford community stroke trial was a randomised trial comparing day hospital attendance with home physiotherapy for elderly stroke patients leaving hospital. The outcome measurements used indicated a consistent modest advantage in favour of home physiotherapy. This advantage is now re-examined in conjunction with the quantified costs of the rehabilitation services and community support received by the two patient groups. The results show that the median cost for the day hospital patients over the first eight weeks was 620.00 pounds (interquartile range 555.00-730.00 pounds) and 385.00 pounds for the home physiotherapy group (interquartile range 240.00-510.00 pounds). These costs were significantly different (median difference 265.00 pounds, 95% confidence interval 190.00-340.00 pounds; p < 0.01). There were no significant differences between the two groups for the indirect costs. This cost-effectiveness study supports the clinical trial result that home physiotherapy should be the treatment of choice for stroke aftercare.