Barbosa, PedroSzrek, HelenaFerreira, Lara NoronhaCruz, Vítor TedimFirmino-Machado, João2024-11-082024-11-082024-05Barbosa, P. M., Szrek, H., Ferreira, L. N., Cruz, V. T., & Firmino-Machado, J. (2024). Stroke rehabilitation pathways during the first year: A cost-effectiveness analysis from a cohort of 460 individuals. Annals of Physical and Rehabilitation Medicine, 67(4), 101824. https://doi.org/10.1016/j.rehab.2024.1018241877-0657http://hdl.handle.net/10400.22/26346Stroke burden challenges global health, and social and economic policies. Although stroke recovery encompasses a wide range of care, including in-hospital, outpatient, and community-based rehabilitation, there are no published cost-effectiveness studies of integrated post-stroke pathways. To determine the most cost-effective rehabilitation pathway during the first 12 months after a f irst-ever stroke. A cohort of people in the acute phase of a first stroke was followed after hospital discharge; 51 % women, mean (SD) age 74.4 (12.9) years, mean National Institute of Health Stroke Scale score 11.7 (8.5) points, and mode modified Rankin Scale score 3 points. We developed a decision tree model of 9 sequences of rehabilitation care organised in 3 stages (3, 6 and 12 months) through a combination of public, semi-public and private entities, considering both the individual and healthcare service perspectives. Health outcomes were expressed as quality-adjusted life years (QALY) over a 1-year time horizon. Costs included healthcare, social care, and productivity losses. Sensitivity analyses were conducted on model input values. From the individual perspective, pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective, followed by pathway 1 (Rehabilitation Centre » Community Clinic). From the healthcare service perspective, pathway 3 was the most cost-effective followed by pathway 7 (Outpatient Hospital » Private Clinic). All other pathways were considered strongly dominated and excluded from the analysis. The total 1-year mean cost ranged between €12104 and €23024 from the individual’s perspective and between €10992 and€31319 fromthe healthcare service perspective. Assuming a willingness-to-pay threshold of one times the national gross domestic product (€20633/QALY), pathway 3 (Short-term Inpatient Unit » Community Clinic) was the most cost-effective strategy from both the individual and healthcare service perspectives. Rehabilitation pathway data contribute to the development of a future integrated care system adapted to different stroke profiles.engPathwayStrokeRehabilitationOutcomesCost-analysisHealth policyjournal article10.1016/j.rehab.2024.1018241877-0655