Cost effectiveness of inpatient rehabilitation in patients with brain injury

Abstract

Rehabilitation following acquired brain injury improves health outcomes, reduces disability, and improves quality of life. We assessed the cost effectiveness of inpatient rehabilitation after brain injury in individuals with brain injury admitted to the Irish national tertiary specialist rehabilitation centre in 2011. Patients' score on the Disability Rating Scale (DRS) was recorded on admission and at discharge after intensive inpatient rehabilitation. Cost savings attributed to the rehabilitation programme were calculated as the difference between direct care costs on admission and discharge. Direct costs of care were calculated as the weekly cost of the care-assistant hours required to care for patients on the basis of their level of disability or daily nursing-home bed cost when this was required. Of 63 patients, complete DRS information for admission and discharge was available for 41. DRS scores, and therefore average levels of functioning, differed signifi cantly at admission (2.3, between mildly and moderately dependent) and discharge (1.1, independent in special environments, p<0.01). Average weekly care costs fell from €629 to €242, with costs recouped within 30 months. Thus, substantial savings result from inpatient rehabilitation, and these savings could have been greater had we considered also the economic benefi t of enabling patients to return to employment.

Impact of specialist rehabilitation services on hospital length of stay and associated costs

“…However, existing studies either lack a control group [4, 5, 7–10] or use inappropriate comparators (e.g. compare levels of rehabilitation intensity or different rehabilitation programmes) [11–14].…”

“…Previous studies suggest that multidisciplinary rehabilitation may reduce length of stay in acute care, reduce continued need for care and improve patient functional outcomes in working age adults with acquired brain injury [ 4 – 6 ]. However, existing studies either lack a control group [ 4 , 5 , 7 – 10 ] or use inappropriate comparators (e.g. compare levels of rehabilitation intensity or different rehabilitation programmes) [ 11 – 14 ].…”

Health services coverage

“…This ratio in comparison to the whole country is two times higher, whereas in the European Region, the ratio of specialist for every one million population is 12[ 23 ] what is certain is that, in order to increase the quality and quantity of experts in this field, needed facilities such as patients beds, creation of infrastructures, and needed space necessary for establishing different rehabilitation centers equipped with trained rehabilitation personnel are vital and necessary. [ 2 24 ] More important point is that at present, more important areas of rehabilitation especially in other disciplines such as neurology, orthopedics, and internal medicine are being made available at inpatient level to think that in Iran, research fellowship programs in Rehabilitation Medicine has not been defined and even in the course of General Medicine the field of rehabilitation has not yet been addressed. By generally looking at the results of the present study, we can see that with regard to other issues, the same is true with regard to human resources such as physiotherapy, occupational therapy, speech therapy, and audiologist; the number in Tehran is more than twice the number employed in comparison to the total number in the country.…”

Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom

“…Although a number of previous authors have reported on cost benefits of rehabilitation,24–26 few have attempted to estimate life-time savings from rehabilitation following TBI: Those who have mainly reported small case studies27 or single-center studies 3,28–30. Three analyses3,28,29 have reported figures from the same post-acute neurobehavioral program in the United Kingdom.…”