脑卒中后社区三级康复治疗的卫生经济学评价

目的：对脑卒中后社区三级康复治疗服务模式进行成本-效果分析。方法：将49例脑卒中患者按社区随机分为康复组和对照组，康复组在常规内科治疗的基础上给予规范的社区三级康复治疗，对照组给予常规内科治疗，没有进行规范的社区康复治疗。分别在入组时、2个月末和5个月末应用临床神经功能缺损程度量表(clinical neural impairment measures scale，NIM)进行神经功能评定，并进行费用调查。结果：规范的社区三级康复治疗2个月末和5个月末，康复组患者的NIM评分分别平均降低了3.26分和4.74分，对照组平均降低了1.08分和1.84分，康复组患者改善程度均显著优于对照组（P<0.01）。在2个月末和5个月末，康复组NIM每降低1分需要的总费用、直接医疗成本、康复治疗费、西药费用分别为￥752.82，￥447.75 ，￥199.89 ，￥241.99和￥1176.76，￥647.01，￥255.52，￥382.22；对照组每提高1分需要相关费用分别为￥2760.36，￥1443.69，￥358.30 ，￥1072.06和￥3899.72，￥1988.45，￥503.91，￥1475.41。对照组约是康复组各项相关费用的2—3倍。结论：社区三级康复治疗服务模式是经济有效的脑卒中社区康复治疗方案。

The cost-effect evaluation on community-based tertiary rehabilitation in stroke patients

Objective:To evaluate the expense of communlty-based tertiary rehabilitation in stroke patients through the cost-effect analysis. Method:Forty-nine subjects were randomly divided into two groups according to their community: the rehabilitation group was administered community-based tertiary rehabilitation in addition to routine interventions of internal medicine; the control group was only given the routine ones without standard community-based rehabilitation. All the patients were assessed with clinical neural impairment measure scale (NIM) at the enrolling time, the end of the 2nd month and the 5th month. At the same time, the cost was investigated. Result: There were no significant difference between the two groups in NIM scores at the entering point. However, 2 months and 5 months later, NIM scores decreased 3.26 and 4.74 in the rehabilitation group respertively,while 1.08 and 1.84 in the control group respectively, both differences were significant between the two groups (P<0.01).At the end of the 2nd month and the 5th month decreased one point of NIM score. The total costs, direct medical costs, total rehabilitation costs and medicine costs of the rehabilitation group were ￥752.82,￥447.75,￥199.89,￥241.99 and ￥1176.76,￥647.01 ,￥255.52,￥382.22 respectively, while the costs of the control group were ￥2760.36,￥1443.69, ￥358.30, ￥1072.06 and ￥3899.72,￥1988.45,￥503.91 and ￥1475.41. Conclusion: Community-based tertiary rehabilitation is an economical and effective medical strategy for stroke patients in community.