Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial.
BACKGROUND
Our previous work showed that providing additional rehabilitation on a Saturday was cost effective in the short term from the perspective of the health service provider. This study aimed to evaluate if providing additional rehabilitation on a Saturday was cost effective at 12 months, from a health system perspective inclusive of private costs.


METHODS
Cost effectiveness analyses alongside a single-blinded randomized controlled trial with 12 months follow up inclusive of informal care. Participants were adults admitted to two publicly funded inpatient rehabilitation facilities. The control group received usual care rehabilitation services from Monday to Friday and the intervention group received usual care plus additional Saturday rehabilitation. Incremental cost effectiveness ratios were reported as cost per quality adjusted life year (QALY) gained and for a minimal clinical important difference (MCID) in functional independence.


RESULTS
A total of 996 patients [mean age 74 years (SD 13)] were randomly assigned to the intervention (n = 496) or control group (n = 500). The intervention was associated with improvements in QALY and MCID in function, as well as a non-significant reduction in cost from admission to 12 months (mean difference (MD) AUD$6,325; 95% CI -4,081 to 16,730; t test p = 0.23 and MWU p = 0.06), and a significant reduction in cost from admission to 6 months (MD AUD$6,445; 95% CI 3,368 to 9,522; t test p = 0.04 and MWU p = 0.01). There is a high degree of certainty that providing additional rehabilitation services on Saturday is cost effective. Sensitivity analyses varying the cost of informal carers and self-reported health service utilization, favored the intervention.


CONCLUSIONS
From a health system perspective inclusive of private costs the provision of additional Saturday rehabilitation for inpatients is likely to have sustained cost savings per QALY gained and for a MCID in functional independence, for the inpatient stay and 12 months following discharge, without a cost shift into the community.


BACKGROUND
Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973213.
School of Allied Health, Department of Rehabilitation, Sport and Nutrition, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia. nbrusco@cabrini.com.au.|Physiotherapy Services, Cabrini Health, 183 Wattletree Road, Malvern, VIC, 3144, Australia. nbrusco@cabrini.com.au.
Natasha Kareem
NK
Brusco
Deakin Health Economics, Population Health SRC, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia. j.watts@deakin.edu.au.
Jennifer J
JJ
Watts
School of Allied Health, Department of Rehabilitation, Sport and Nutrition, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia. n.shields@latrobe.edu.au.|Department of Allied Health, Northern Health, 1231 Plenty Road, Bundoora, VIC, 3083, Australia. n.shields@latrobe.edu.au.
Nora
N
Shields
School of Allied Health, Department of Rehabilitation, Sport and Nutrition, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, 3086, Australia. n.taylor@latrobe.edu.au.|Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold Street, Box Hill, VIC, 3128, Australia. n.taylor@latrobe.edu.au.
Nicholas F
NF
Taylor
D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017028:Caregivers; D003362:Cost-Benefit Analysis; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012046:Rehabilitation / Q000191:economics*