脑卒中康复治疗的成本效果研究

The cost-effectiveness of stroke rehabilitation care： a systematic review of randomized controlled trails studies

目的对国际发表的脑卒中患者康复治疗的随机对照试验研究（RCTs）的成本效果评估文献进行系统分析，为我国康复治疗的医疗保险支付及临床治疗决策提供循证依据。 方法纳入公开发表的脑卒中康复治疗与传统治疗的RCT研究，对治疗效果、资源利用及成本等产出指标进行研究汇总。结果纳入8项RCT研究，其中4篇文献涉及支持性早期出院计划（ESD），较传统治疗成本低，临床效果相似（3篇）或更好（1篇）；2篇文献涉及家庭康复治疗，成本具有中立性或较低各1篇，临床效果差异无统计学意义（P〉0.05）；1篇文献涉及卒中单元照顾，较传统治疗临床效果好，但成本高；1篇文章涉及整合卒中服务，较传统治疗成本低，临床效果差异无统计学意义（P〉0.05）。结论脑卒中患者加大康复治疗的投入具有较好的成本效果优势，积极推动康复治疗会带来临床收益，对提高医疗资源利用效率、提高患者生存质量等具重要意义。

ObjectiveTo perform a systematic review of the literature on the cost-effectiveness of stroke rehabilitation care, and to provide evidence for medical insurance payment and clinical decision making on stroke rehabilitation care.MethodsWe included published randomized controlled trails（RCTs）which compared rehabilitation care（RC）and usual care（UC）on stroke, and summarized clinical outcome, resource use, costs, and other indexes as outcomes of interest.ResultsAmong included eight RCT studies, the results of four models of stroke care were found as following.（1）Four studies involving early supported discharge（ESD）showed lower costs in rehabilitation care, but similar（n=3）or better（n=1）clinical outcome.（2）Two studies involving home-based rehabilitation showed similar costs in one and lower costs in the other, with no difference in clinical outcome between two trials.（3）One study involving stroke unit care showed higher costs and better clinical outcome.（4）One trial involving integration stroke service was associated with lower costs, but no difference in the effectiveness. ConclusionsFor patients with stroke, rehabilitation care leads to significant improvements on cost-effectiveness.Promoting the clinical use of rehabilitation care will bring about clinical benefits, increase the efficiency of medical resources use, and improve patient′s quality of life.