OBJECTIVES: Stroke is a major contributor for long term disability and socioeconomic burden. In Taiwan, nationwide Post-Acute Care (PAC) program for stroke has been launched by National Health Insurance since 2014. In this study, we compare the cost-effectiveness between PAC and non-PAC for stroke patient after discharge from acute hospital care.

METHODS: Data were obtained from two types of sources: one is from National Health Insurance (NHI) Dataset and the other one is from patient survey. For claim data, we defined stroke according to the ICD-9-CM codes 430 to 437, and all patients were followed up for at least one year. PAC group and non-PAC groups were risk adjusted by the propensity score to make the two groups comparable. Direct medical costs were estimated from the claim data. Face-to-face survey was administered to collect indirect costs and quality of life information for patients at three time points: immediately after discharge, one month after discharge and three-month after first follow up.

RESULTS: Our results show that most of the stroke patients (85%) returned home directly after being discharged from hospital, and few patients adopted PAC during our study period. The direct medical costs were around NT$14,872 within the first month after discharge, NT$15,497 between the first month to the third month, and NT$19,361 between the third month to the sixth month. PAC (3-6 weeks and maximum 12 weeks) costs were much higher during the first month (which is between NT$75000 to 89,300). However, the indirect costs, which include the caregiver costs, facility remodel, assistance device, transportation, and more, were much higher for non-PAC groups compared to PAC groups. The EQ-5D showed that patients’ quality of life improved during the following up (0.3629, 0.5494 and 0.4892 respectively).

CONCLUSIONS: During the study period, PAC was demonstrated to be cost-effective for stroke patients.