Estimating the costs and benefits of stroke rehabilitation in South Africa

Objective This paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation. Design We report an economic modelling approach using a worked cost-effectiveness to validate the argument for the cost-saving benefits of stroke rehabilitation. Setting South African health care, employing analysis of available secondary data from South African research and government reports. Participants In line with international trends in stroke epidemiology, we focused on people who were employed prior to having their stroke, with return-to-work as the desired rehabilitation outcome. Interventions Not applicable. Main outcome measure(s) We used information on stroke rehabilitation and secondary data derived from grey and published literature, to determine if early stroke rehabilitation represents value for money from the government perspective. For our worked example, we used return-to-work rates, intervention costs, and the cost of rehabilitation services to estimate cost-savings as a result of an individualized workplace intervention. Results The cost of delivering the individualized intervention was estimated at R5633/patient. Combining survivor rates, return-to-work rate, and costs of the programme, a work intervention programme could result in a net saving of R133.1 million over 5 years (or about R26.6 per year (discount 3%). Conclusion The value of rehabilitation should not be considered in terms of cost-effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.