title: A cost analysis of specialist inpatient neurorehabilitation services in the UK.
abstract: OBJECTIVE
  To determine the range and variation in costs and service characteristics between different levels of specialist neurorehabilitation services in England, and to determine key predictors of service costs.
  
  
  METHODS
  A retrospective analysis of service costs, staffing and activity levels, with comparison across service types.
  
  
  METHODS
  Specialist neurorehabilitation services (n = 17) from different areas of England, were divided into three types according to predefined criteria: adult level 1 (tertiary) (n = 8) and level 2a (supra-district) (n = 7) services; and children's services (n = 2).
  
  
  METHODS
  Annual service costs were collated using a standard costing template, and divided according to principal cost type (direct/indirect/overheads) and behaviour (variable/non-variable). For comparison between the level 1 and 2a services, costs and service characteristics were calculated per occupied bed.
  
  
  RESULTS
  The percentage breakdown of costs was consistent across all three service types, with direct costs making up 83%, indirect 10%, and overheads 7% of total costs. The median variable component ranged from 75 to 76%. Staff pay made up 66% and accounted for 95% of the variance of the total costs in adult services. Level 1 services had higher total staffing costs, mainly reflecting higher therapy staff numbers (z = -2.0, P = 0.05). The median total costs/bed-day were: level 1 £530 (interquartile range (IQR) 435-574) (equivalent to US$860 or €650) and level 2a £402 (US$650 or €459) (IQR 326-451) (z = -2.5, P = 0.009). Children's services cost almost twice that (£1017-1177).
  
  
  CONCLUSIONS
  Expected variations in cost are largely due to differences in staff costs. Total staff costs projected by 150% provided a reasonable estimate of total unit costs.
authors: King's College London School of Medicine, Department of Palliative Care, Policy and Rehabilitation, London, UK. lynne.turner-stokes@dial.pipex.com
authors: Lynne
authors: L
authors: Turner-Stokes
authors: Alan
authors: A
authors: Bill
authors: Robert
authors: R
authors: Dredge
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D004180:Direct Service Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D008511:Medicine; D009422:Nervous System Diseases / Q000175:diagnosis / Q000534:rehabilitation*; D012047:Rehabilitation Centers / Q000191:economics; D012189:Retrospective Studies; D013038:Specialization / Q000191:economics*; D013222:State Medicine / Q000191:economics*; D011795:Surveys and Questionnaires; D006113:United Kingdom