The cost-effectiveness of life after stroke services and the impact of these services on health and social care resource use: a rapid review
Authors: Pisavadia Kalpa , Anthony Bethany Fern , Davies Jacob , Roberts Sofie , Granger Rachel , Spencer Llinos Haf , Gillen Elizabeth , Hounsome Juliet , Noyes Jayne , Fitzsimmons Deborah , Edwards Rhiannon Tudor , Edwards Adrian , Cooper Alison , Lewis Ruth 
Published: November 2024

In the UK, more than 100,000 strokes occur each year, and this is expected to rise to over 2.1 million by 2035. Life after stroke services aim to support peoples physical and emotional state, are complimentary to rehabilitation and take a non-medical holistic approach to living well after a stroke. This rapid review aimed to identify evidence on the cost-effectiveness of life after stroke services, and the impact of these interventions on health or social care resource use. The review included evidence from 12 studies (7 economic evaluations and 5 randomised controlled trials), published between January 2000 and August 2024.

The economic evaluations assessed a number of interventions to support stroke survivors, their families and caregivers. Two of the randomised controlled trials were partial economic evaluations, reporting on cost and resource use data related to training caregivers, and an arts and health-based intervention. The other three trials reported on resource use but not cost data, and assessed family support interventions, and a telehealth intervention to assist stroke survivors and their carers. There was a lack of evidence on the cost-effectiveness of life after stroke as a comprehensive service. However, this review identified evidence on the cost-effectiveness and resource utilisation of specific interventions within these services.

Findings include that a community-based Individual Management Program for post-stroke survivors was cost-effective from a societal perspective at 24-month follow-up. A carer training intervention, delivered whilst the stroke patient was in hospital, was associated with a reduction in health and social care resource use when evaluated at a single hospital. However, this intervention was not cost-effective when rolled out and assessed across multiple hospitals. Other findings included that a combination of speech and language therapy with voluntary support services had a lower cost per session compared to NHS speech and language therapy alone. Family support organiser interventions for stroke survivors and carers were associated with reduced healthcare utilisation. To fully understand the effectiveness and cost-effectiveness of life after stroke interventions, research is needed to assess potential long-term impacts. A reduction in resource use may be associated with cost savings and reduced burden on the NHS. However, an increase in health care and social care use may also be appropriate due to better signposting or identification of peoples’ needs. Evidence is also needed on the cost-effectiveness of supporting stroke survivors in returning to the workforce. Many of the sample sizes in the included studies lacked ethnic diversity. Stroke trials need strategies to achieve equity of access. This review focused on evidence of cost-effectiveness and resource utilisation. Decisions relating to policy and practice should also consider evidence on clinical effectiveness and patient preferences.