Published Online
on January 30, 2003

A more recent version of this article appeared on February 1, 2003

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Submitted on July 24, 2002
Accepted on August 2, 2002

Costs and Caregiver Consequences of Early Supported Discharge for Stroke Patients

Josephine Teng BSc; Nancy E. Mayo PhD^*; Eric Latimer PhD; Jim Hanley PhD; Sharon Wood-Dauphinee PhD; Robert Côté MD, FRCP; and Susan Scott MSc

From the Joint Department of Biostatistics and Epidemiology and Occupational Health, Faculty of Medicine (J.T., N.E.M., E.L., J.H., S.W.-D.), School of Physical and Occupational Therapy Faculty of Medicine (N.E.M., S.W.-D.), and Departments of Psychiatry and Economics (E.L.), McGill University; Division of Clinical Epidemiology, McGill University Health Center, Royal Victoria Hospital Site (N.E.M., J.H., S.W.-D., S.S.); and Department of Neurology, McGill University Health Center, Montreal General Hospital Site (R.C.), Montreal, Quebec, Canada.

^* To whom correspondence should be addressed. E-mail: nancy.mayo{at}mcgill.ca.

Background and Purpose--Early supported discharge (ESD) for stroke has been shown to yield outcomes similar to or better than those of conventional care, but there is less information on the impact on costs and on the caregiver. The purpose of this study is to estimate the costs associated with an ESD program compared with those of usual care.

Methods--We conducted a randomized controlled trial of stroke patients who required rehabilitation services and who had a caregiver at home.

Results--Acute-care costs incurred before randomization when patients were medically ready for discharge averaged $3251 per person. The costs for the balance of the acute-care stay, from randomization to discharge, were $1383 for the home group and $2220 for the usual care group. The average cost of providing the 4-week home intervention service was $943 per person. The total cost generated by persons assigned to the home group averaged $7784 per person, significantly lower than the $11 065 per person for those assigned to usual care. A large proportion of the cost differential between the 2 groups arose from readmissions, for which the usual care group generated costs more than quadruple those of the home intervention group.

Conclusions--Providing care at home was no more (or less) expensive for those with greater functional limitation than for those with less. Caregivers in the ESD group scored consistently lower on the Burden Index than caregivers with usual care, even caregivers of persons with major functional limitations. For persons recovering from stroke and their families, ESD provides a cost-effective alternative to usual care.

Key words: caregivers • cost-benefit analysis • rehabilitation • stroke

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