title: Reablement in community-dwelling older adults: a cost-effectiveness analysis alongside a randomized controlled trial.
abstract: BACKGROUND
  In the face of a growing number of older adults in the population, policy-makers in high-income countries are seeking new ways to reduce the expected growth in long-term care expenditure. Research shows that disability is an important determinant of long-term care utilization. In this context, reablement has received increased attention. Reablement is a form of home-based rehabilitation, which focuses on improving independent functioning in daily activities perceived as important by the older adult.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of reablement.
  
  
  METHODS
  The economic evaluation is based on data from a randomized controlled trial in which all participants were assessed at baseline and after 3 and 9 months. The intervention group participated in reablement, while the control group received usual care. The Canadian Occupational Performance Measure (COPM) was used to measure self-perceived activity performance and satisfaction with performance. Cost data were based on daily registrations of usage of home-based care personnel during a period of 9 months.
  
  
  RESULTS
  Reablement was found to be more cost-effective than usual care. The assessments of performance and satisfaction regarding daily activities were significantly higher in the reablement group compared with the control group and this was achieved at lower cost. Importantly too, in the post-trial period, the intervention group requested significantly fewer home visits which were, on average, of significantly shorter duration compared with the control group. Expenditure on home visits was significantly lower for the reablement group.
  
  
  CONCLUSIONS
  Reablement is a more cost-effective intervention compared with usual care. Reablement has a potentially large effect on the demand for compensating home-based care services. Policy-makers should therefore consider implementing reablement on a larger scale.
authors.affiliation: Uni Research Rokkan Centre, P.O. Box 7810, Bergen, 5020, Norway. Egil.Kjerstad@uni.no.
authors.forename: Egil
authors.initials: E
authors.lastname: Kjerstad
authors.affiliation: Centre for Care Research Western Norway and Department of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, P.O. Box 7030, Bergen, Norway.
authors.forename: Hanne Kristin
authors.initials: HK
authors.lastname: Tuntland
keywords: Economic evaluation; Home care services; Randomized controlled trial; Rehabilitation