Societal burden of stroke rehabilitation: Costs and health outcomes after admission to stroke rehabilitation.
Winke van Meijeren-Pont, Sietske J Tamminga, Paulien H Goossens and 6 others
PMID 33856036WHAT IT FOUND
Stroke rehabilitation costs one year post-admission averaged US$70,601 for inpatients and US$27,473 for outpatients.
Inpatient utility scores improved significantly over 12 months, while outpatient scores remained stable. Lower baseline health predicted higher total costs.
Key findings
01Mean total societal costs in the first year after admission were US$70,601 for inpatients and US$27,473 for outpatients.
02For inpatients, rehabilitation was the largest cost contributor at 66% of the total, whereas for outpatients it accounted for 36%, with productivity loss making up a similar proportion at 34%.
03Inpatient utility scores improved significantly between baseline and 6 months, and between baseline and 12 months, but outpatient scores did not change significantly over time.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study only accounted for costs starting from admission to rehabilitation, excluding acute care costs such as ambulance, hospital stay, and thrombolysis, which likely underestimates the total societal burden. There was significant missing data, particularly for absenteeism (38% missing) and quality of life measures, which were addressed using multiple imputation, potentially introducing bias. Selection bias is possible as 54% of eligible patients were either not invited or refused participation, and those who refused may have had different functional or cognitive limitations. The study design did not allow for a direct comparison of outcomes between inpatients and outpatients due to significant baseline differences in clinical characteristics, such as age and functional status. Costs are reported for the Netherlands and may not be generalizable to other healthcare systems with different pricing and reimbursement structures.
Declared interests
The work was supported by the Stichting Kwaliteitsgelden Medisch Specialisten. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the higher costs for inpatients as evidence that inpatient rehabilitation is more effective than outpatient care. The two groups differed significantly in baseline characteristics, with inpatients being older and having different impairment profiles, making direct cost-effectiveness comparisons invalid.