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Multicenter Study
. 2019 Jul/Aug;34(4):205-214.
doi: 10.1097/HTR.0000000000000473.

Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom

Lynne Turner-Stokes  1 , Mendwas Dzingina, Robert Shavelle, Alan Bill, Heather Williams, Keith Sephton
Affiliations
Multicenter Study

Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom

Lynne Turner-Stokes et al. J Head Trauma Rehabil. 2019 Jul/Aug.

Abstract

Objectives: To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care.

Setting/participants: TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010-2018.

Design: A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database.

Main measures: Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings.

Results: The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786).

Conclusions: Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.

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Figures

Figure 1.
Figure 1.
The data extraction process. Of 6043 adults (16 years and older) with severe TBI admitted for specialist rehabilitation in a level 1 or 2 service, 3578 had the requisite NPDS and FIM data to calculate life-time savings. Of these, 289 (8%) were admitted for assessment of disordered conscious only and were discharged still in persistent VS, while the remaining 3289 were the active rehabilitation group. FIM indicates Functional Independence Measure; NPDS, Northwick Park Dependency Score; VS, vegetative state.
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References

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    1. Turner-Stokes L, Williams H, Bill A, Bassett P, Sephton K. Cost-efficiency of specialist inpatient rehabilitation for working-aged adults with complex neurological disabilities: a multicentre cohort analysis of a national clinical data set. BMJ Open. 2016;6(2):e010238. - PMC - PubMed

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