Cost-efficiency of longer-stay rehabilitation programmes: can they provide value for money?
OBJECTIVE
To examine the cost-efficiency of longer stay rehabilitation in patients with complex neurological disabilities.


METHODS
Longitudinal cohort analysis of consecutive admissions to a specialized in-patient rehabilitation unit.


METHODS
patients who were highly dependent on admission (NPDS > or = 25) and had a length of stay > 125 days. Serial changes in dependency and care costs were measured by the Northwick Park Dependency and Care Needs Assessment (NPDS/NPCNA), which provides a generic estimation of dependency, care hours and weekly cost of continuing care in the community.


RESULTS
Of 410 admissions over 5 years, 51 met the case-selection criteria - mean age 39 +/- 17 years, male:female ratio 2:1. The mean length of stay (LOS) was 184 +/- 56 days (max 312). Between 4 months and discharge (mean 58 +/- 56 days later) significant changes were seen in dependency (t = 4.8, p < 0.0001) and care costs (t = 2.0, p < 0.05). The mean additional cost of rehabilitation beyond 4 months ( pound sterling 16 766 +/- 17 334) would be offset by the mean weekly savings in cost of care within 36 months. The two cases who stayed > 300 days are presented in more detail.


CONCLUSIONS
The additional investment in longer-stay rehabilitation in this group of complex patients was offset relatively quickly by long-term savings in the cost of care.
Turner-Stokes
Lynne
L
Regional Rehabilitation Unit, Northwick Park Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK. lynne.turner-stokes@dial.pipex.com
D000328:Adult; D001930:Brain Injuries / Q000191:economics / Q000534:rehabilitation; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics*; D008137:Longitudinal Studies; D008297:Male; D009422:Nervous System Diseases / Q000191:economics* / Q000534:rehabilitation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012047:Rehabilitation Centers / Q000191:economics*; D020521:Stroke / Q000191:economics; D000071939:Stroke Rehabilitation; D006113:United Kingdom