Economic evaluation of a geriatric rehabilitation programme: a randomized controlled trial

Abstract

Objective: Cost-effectiveness of a geriatric rehabilitation programme.

Design: Economic evaluation alongside a randomized controlled trial.

Methods: A total of 741 subjects with progressively decreasing functional ability and unspecific morbidity were randomly assigned to either an inpatient rehabilitation programme (intervention group) or standard care (control group). The difference between the mean cost per person for 12 months' care in the rehabilitation and control groups (incremental cost) and the ratio between incremental cost and effectiveness were calculated. Clinical outcomes were functional ability (Functional Independence Measure (FIM(TM))) and health-related quality of life (15D score).

Results: The FIM(TM) score decreased by 3.41 (standard deviation 6.7) points in intervention group and 4.35 (standard deviation 8.0) in control group (p = 0.0987). The decrease in the 15D was equal in both groups. The mean incremental cost of adding rehabilitation to standard care was 3111 euros per person. The incremental cost-effectiveness ratio for FIMTM did not show any clinically significant change, and the rehabilitation was more costly than standard care. A cost-effectiveness acceptability curve suggests that if decision-makers were willing to pay 4000 euros for a 1-point improvement in FIMTM, the rehabilitation would be cost-effective with 70% certainty.

Conclusion: The rehabilitation programme was not cost-effective compared with standard care, and further development of outpatient protocols may be advisable.