Publicação
Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals
| datacite.subject.sdg | 03:Saúde de Qualidade | |
| datacite.subject.sdg | 10:Reduzir as Desigualdades | |
| datacite.subject.sdg | 01:Erradicar a Pobreza | |
| dc.contributor.author | Barbosa, Pedro Maciel | |
| dc.contributor.author | Szrek, Helena | |
| dc.contributor.author | Ferreira, Lara | |
| dc.contributor.author | Cruz, Vitor Tedim | |
| dc.contributor.author | Firmino-Machado, João | |
| dc.date.accessioned | 2026-04-16T09:14:21Z | |
| dc.date.available | 2026-04-16T09:14:21Z | |
| dc.date.issued | 2024-05 | |
| dc.description.abstract | Background: Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. Objective: To determine the most cost-effective rehabilitation pathway during the first 12 months after a first-ever stroke. Methods: A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were con ducted on model input values. Results: From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual’s perspective and between €10992 and €31319 from the healthcare service perspective. Conclusion: Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles. | eng |
| dc.identifier.doi | 10.1016/j.rehab.2024.101824 | |
| dc.identifier.issn | 1877-0657 | |
| dc.identifier.uri | http://hdl.handle.net/10400.1/28691 | |
| dc.language.iso | eng | |
| dc.peerreviewed | yes | |
| dc.publisher | Elsevier | |
| dc.relation.ispartof | Annals of Physical and Rehabilitation Medicine | |
| dc.rights.uri | http://creativecommons.org/licenses/by-nc-nd/4.0/ | |
| dc.subject | Pathway | |
| dc.subject | Stroke | |
| dc.subject | Rehabilitation | |
| dc.subject | Outcomes | |
| dc.subject | Cost-analysis | |
| dc.subject | Health policy | |
| dc.title | Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals | eng |
| dc.type | journal article | |
| dspace.entity.type | Publication | |
| oaire.citation.issue | 4 | |
| oaire.citation.title | Annals of Physical and Rehabilitation Medicine | |
| oaire.citation.volume | 67 | |
| oaire.version | http://purl.org/coar/version/c_970fb48d4fbd8a85 | |
| person.familyName | Ferreira | |
| person.givenName | Lara | |
| person.identifier.ciencia-id | 761A-3037-8E22 | |
| person.identifier.orcid | 0000-0003-2378-7750 | |
| person.identifier.rid | B-7575-2019 | |
| person.identifier.scopus-author-id | 24491766400 | |
| relation.isAuthorOfPublication | e93501ac-9707-4e92-bb2c-cc91bc09b428 | |
| relation.isAuthorOfPublication.latestForDiscovery | e93501ac-9707-4e92-bb2c-cc91bc09b428 |