Evaluation of Cost‐Effectiveness of a Virtual Multidisciplinary Stroke Care Clinic for Community‐Dwelling Survivors of Stroke

Abstract

Background A technologically integrated, multidisciplinary approach to stroke rehabilitation service was delivered and embedded into conventional health care practice. This article reports an evaluation of cost‐effectiveness analysis of a new Virtual Multidisciplinary Stroke Care Clinic (VMSCC) service for community‐dwelling survivors of stroke. Methods and Results A randomized controlled trial was conducted. Adults with a first/recurrent ischemic/hemorrhagic stroke were recruited from 10 hospitals. Eligible participants were randomly assigned to receive the VMSCC service (individual virtual consultations with a registered nurse, home blood pressure telemonitoring, and unlimited access to an online resource platform) plus usual care or usual care alone. Cost‐effectiveness analyses were performed based on incremental cost‐effectiveness ratios expressed as incremental cost per emergency admission reduced, and day of hospitalization reduced over the study period. A total of 256 participants (intervention group n=141 versus control group n=115) with complete cost and health care use data were included in the cost‐effectiveness analyses. The VMSCC service, on average, resulted in a greater reduction in the number of emergency admission (−0.06 [95% bootstrapped CI, −0.14 to 0.01]) and fewer days of hospitalization (−0.08, [95% bootstrapped CI −0.40 to 0.24]) but incurred a higher total cost of HK$375 (95% bootstrapped CI, −2103 to 2743) compared with the usual care. The incremental cost‐effectiveness ratios of the VMSCC service compared with the usual care were HK$6070 and HK$4826 per an emergency admission and a day of hospital stay reduced respectively. Conclusions The study provides preliminary but not confirmative evidence that the VMSCC service could be more effective but more costly than usual care in reducing health service use. Registration URL: https://www.chictr.org.cn. Unique identifier: ChiCTR1800016101.

Keywords

• cost‐effectiveness analysis
• self‐management
• stroke
• telerehabilitation