Home or hospital for stroke rehabilitation? Results of a randomized controlled trial - II: Cost minimization analysis at 6 months

Background and Purpose-The goal of the present study was to examine the res ource and economic implications of an early hospital discharge and home-bas ed rehabilitation scheme for patients with acute stroke. Methods-A cost minimization analysis in conjunction with a randomized contr olled trial was carried out at 2 affiliated teaching hospitals in the south ern metropolitan region of Adelaide, South Australia, between 1997 and 1998 . Eighty-six hospitalized patients with acute stroke who required rehabilit ation were randomized to receive both early hospital discharge and home-bas ed rehabilitation, or conventional in-hospital rehabilitation and community care. Direct and indirect costs related to stroke rehabilitation were calc ulated, including hospital bed days, home-based intervention program, commu nity services, and personal expenses during the 6 months after randomizatio n. Results-The mean cost per patient was lower for patients randomized to the early hospital discharge and home-based rehabilitation ($8040) compared wit h those who received conventional care ($10 054). This cost saving was not statistically significant (P = 0.14). However, sensitivity analyses indicat ed that the cost of home-based rehabilitation was consistently lower than t hat of conventional care except when hospital costs were assumed to be 50% less than these used in the main analysis. Multiple regression analysis dem onstrated that the cost of the home-based program was significantly related to a patient's level of disability after adjustment fur age, comorbidity, and the: presence or absence of a caregiver. Conclusions-The early hospital discharge and home-based rehabilitation sche me was less costly than conventional hospital care for patients with stroke . Limitation of the provision of such services to patients with mild disabi lity is likely to be most cost effective.