title: Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set.
abstract: OBJECTIVE
  To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multicentre cohort of inpatients with complex neurological disability, comparing different diagnostic groups across 3 levels of dependency.
  
  
  METHODS
  A multicentre cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database, 2010-2015.
  
  
  METHODS
  All 62 specialist (levels 1 and 2) rehabilitation services in England.
  
  
  METHODS
  Working-aged adults (16-65 years) with complex neurological disability.
  
  
  METHODS
  all episodes with length of stay (LOS) 8-400 days and complete outcome measures recorded on admission and discharge. Total N=5739: acquired brain injury n=4182 (73%); spinal cord injury n=506 (9%); peripheral neurological conditions n=282 (5%); progressive conditions n=769 (13%).
  
  
  METHODS
  Specialist inpatient multidisciplinary rehabilitation.
  
  
  METHODS
  Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA). Functional independence: UK Functional Assessment Measure (UK Functional Independence Measure (FIM)+FAM). Cost-efficiency: (1) time taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care, (2) FIM efficiency (FIM gain/LOS days), (3) FIM+FAM efficiency (FIM+FAM gain/LOS days). Patients were analysed in 3 groups of dependency.
  
  
  RESULTS
  Mean LOS 90.1 (SD 66) days. All groups showed significant reduction in dependency between admission and discharge on all measures (paired t tests: p<0.001). Mean reduction in 'weekly care costs' was greatest in the high-dependency group at £760/week (95% CI 726 to 794)), compared with the medium-dependency (£408/week (95% CI 370 to 445)), and low-dependency (£130/week (95% CI 82 to 178)), groups. Despite longer LOS, time taken to offset the cost of rehabilitation was 14.2 (95% CI 9.9 to 18.8) months in the high-dependency group, compared with 22.3 (95% CI 16.9 to 29.2) months (medium dependency), and 27.7 (95% CI 15.9 to 39.7) months (low dependency). FIM efficiency appeared greatest in medium-dependency patients (0.54), compared with the low-dependency (0.37) and high-dependency (0.38) groups. Broadly similar patterns were seen across all 4 diagnostic groups.
  
  
  CONCLUSIONS
  Specialist rehabilitation can be highly cost-efficient for all neurological conditions, producing substantial savings in ongoing care costs, especially in high-dependency patients.
authors.affiliation: Faculty of Life Sciences and Medicine, Department of Palliative Care, Policy and Rehabilitation, King's College London, London, UK Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK.
authors.forename: Lynne
authors.initials: L
authors.lastname: Turner-Stokes
authors.affiliation: Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Williams
authors.affiliation: Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Bill
authors.affiliation: Statsconsultancy Ltd, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Bassett
authors.affiliation: Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, UK.
authors.forename: Keith
authors.initials: K
authors.lastname: Sephton
mesh_terms: D000203:Activities of Daily Living; D015331:Cohort Studies; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D004739:England; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000191:economics* / Q000534:rehabilitation*; D011446:Prospective Studies; D020127:Recovery of Function; D012047:Rehabilitation Centers / Q000191:economics* / Q000706:statistics & numerical data; D013038:Specialization / Q000191:economics* / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: cost-efficiency; dependency; outcome measurement