Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT)

Tay-Teo, K., Moodie, M., Bernhardt, J., Thrift, A., Collier, J., Donnan, G. and Dewey, H. 2008, Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT), Cerebrovascular diseases, vol. 26, no. 5, pp. 475-481.

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Title Economic evaluation alongside a phase II, multi-centre, randomised controlled trial of very early rehabilitation after stroke (AVERT)
Author(s) Tay-Teo, K.
Moodie, M.
Bernhardt, J.
Thrift, A.
Collier, J.
Donnan, G.
Dewey, H.
Journal name Cerebrovascular diseases
Volume number 26
Issue number 5
Start page 475
End page 481
Total pages 7
Publisher S. Karger AG
Place of publication Basel, Switzerland
Publication date 2008
ISSN 1015-9770
1421-9786
Keyword(s) health care costs
early ambulation - economics
health services - economics
stroke - economics
stroke - rehabilitation
Summary BACKGROUND/PURPOSE: The effectiveness and costs of very early rehabilitation after stroke are unknown. This study assessed the cost effectiveness of very early mobilisation in addition to standard care (VEM) compared with standard care alone (SC). METHODS: Cost-effectiveness analysis alongside a phase II, multi-centre, randomised controlled trial (RCT) with blinded outcome assessments. Less than 24 h after stroke, patients were recruited from two stroke units and randomised to receive VEM or SC. The intervention continued until discharge or 14 days, whichever was sooner. The efficacy measure was a dichotomised modified Rankin Scale (mRS) at 3 months with mRS < or =2 representing good outcome. Costs were determined from medical records and patient interviews at 3, 6 and 12 months. National average (where available) or local costs were applied for the reference year 2004. Differences in mean total costs at 3 and 12 months were tested using t test assuming unequal variances. An incremental cost-effectiveness ratio was calculated and probabilistic uncertainty analysis was undertaken. RESULTS: The sample consisted of 38 VEM and 33 SC patients. A trend for good outcome with VEM compared to SC was found (adjusted OR 4.10, 95% CI 0.99-16.88, p = 0.051). Patients receiving VEM incurred significantly less costs at 3 months (AUD 13,559) compared with SC (AUD 21,860; p = 0.02). This difference in mean per patient total cost persisted at the 12-month assessment (VEM: AUD 17,564; SC: AUD 29,750; p = 0.03). VEM was found to be a 'dominant' (more effective, less cost) intervention when compared to SC at 3 months. CONCLUSION: These findings provide preliminary evidence that VEM is likely to be cost-effective. A large RCT is currently underway to confirm the cost effectiveness of VEM.
Language eng
Field of Research 110903 Central Nervous System
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1 Refereed article in a scholarly journal
HERDC collection year 2008
Copyright notice ©2008, S. Karger AG
Persistent URL http://hdl.handle.net/10536/DRO/DU:30017370

Document type: Journal Article
Collection: Public Health Research, Evaluation, and Policy Cluster
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