Effect of Increased Intensity of Physiotherapy on Patient Outcomes After Stroke: An Economic Literature Review and Cost-Effectiveness Analysis

Abstract

Background: Functional improvements have been seen in stroke patients who have received an increased intensity of physiotherapy. This requires additional costs in the form of increased physiotherapist time.

Objectives: The objective of this economic analysis is to determine the cost-effectiveness of increasing the intensity of physiotherapy (duration and/or frequency) during inpatient rehabilitation after stroke, from the perspective of the Ontario Ministry of Health and Long-term Care.

Data sources: The inputs for our economic evaluation were extracted from articles published in peer-reviewed journals and from reports from government sources or the Canadian Stroke Network. Where published data were not available, we sought expert opinion and used inputs based on the experts' estimates.

Review methods: The primary outcome we considered was cost per quality-adjusted life-year (QALY). We also evaluated functional strength training because of its similarities to physiotherapy. We used a 2-state Markov model to evaluate the cost-effectiveness of functional strength training and increased physiotherapy intensity for stroke inpatient rehabilitation. The model had a lifetime timeframe with a 5% annual discount rate. We then used sensitivity analyses to evaluate uncertainty in the model inputs.

Results: We found that functional strength training and higher-intensity physiotherapy resulted in lower costs and improved outcomes over a lifetime. However, our sensitivity analyses revealed high levels of uncertainty in the model inputs, and therefore in the results.

Limitations: There is a high level of uncertainty in this analysis due to the uncertainty in model inputs, with some of the major inputs based on expert panel consensus or expert opinion. In addition, the utility outcomes were based on a clinical study conducted in the United Kingdom (i.e., 1 study only, and not in an Ontario or Canadian setting).

Conclusions: Functional strength training and higher-intensity physiotherapy may result in lower costs and improved health outcomes. However, these results should be interpreted with caution.

Figure 1:. Schematic Diagram of Model Structure for 2-State Markov Model

Figure 2:. Cost-Effectiveness Plane Showing Incremental Cost-Effectiveness Ratios for Higher-Intensity PT Versus Conventional PT

Figure 3:. Cost-Effectiveness Plane Showing Incremental Cost-Effectiveness Ratios for FST Plus Conventional PT, Versus Conventional PT

Figure 4:. Cost-Effectiveness Plane Showing Cost-Effectiveness Acceptability Curve for Higher-Intensity PT Versus Conventional PT

Figure 5:. Cost-Effectiveness Plane Showing Cost-Effectiveness Acceptability Curve for FST Plus Conventional PT, Versus Conventional PT