Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-12-2015 | Research article

Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial

Authors: Natasha Kareem Brusco, Jennifer J Watts, Nora Shields, Nicholas F Taylor

Published in: BMC Health Services Research | Issue 1/2015

Login to get access

Abstract

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.

Trial registration

Australian and New Zealand Clinical Trials Registry November 2009 ACTRN12609000973​213.
Appendix
Available only for authorised users
Literature
1.
Stucki G, Cieza A, Melvin J. The international classification of functioning, disability and health: A unifying model for the conceptual description of the rehabilitation strategy. J Rehabil Med. 2007;39(4):279–85.CrossRefPubMed
2.
Brusco NK, Taylor NF, Watts JJ, Shields N. Economic evaluation of adult rehabilitation: a systematic review and meta-analysis of randomized controlled trials in a variety of settings. Arch Phys Med Rehabil. 2014;95(1):94–116.CrossRefPubMed
3.
Brusco NK, Watts JJ, Shields N, Taylor NF. Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up. BMC Med. 2014;12:89. doi:10.1186/1741-7015-12-89.CrossRefPubMedPubMedCentral
4.
Peiris C, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial. BMC Med. 2013;11:198.CrossRefPubMedPubMedCentral
5.
6.
Brusco NK, Watts JJ, Shields N, Chan SP, Taylor NF. Does additional acute phase inpatient rehabilitation help people return to work? A subgroup analysis from a randomized controlled trial. Clin Rehab. 2014;28(8):754–61.CrossRef
7.
Anderson C, Mhurchu CN, Rubenach S, Clark M, Spencer C, Winsor A. Home or hospital for stroke rehabilitation? Results of a randomized controlled trial II: cost minimization analysis at 6 months. Stroke. 2000;31(5):1032–7.CrossRefPubMed
8.
Kalra L, Evans A, Perez I, Knapp M, Swift C, Donaldson N. A randomised controlled comparison of alternative strategies in stroke care. Health Technol Assess. 2005;9(18):iii–iv. 18.CrossRefPubMed
9.
Taylor NF, Brusco NK, Watts JJ, Shields N, Peiris C, Sullivan N, et al. A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes. BMC Health Serv Res. 2010;10:308.CrossRefPubMedPubMedCentral
10.
Husereau D, Drummond M, Petrou S, Carswell C, Moher D, Greenberg D, et al. Consolidated Health Economic Evaluation Reporting Standards (CHEERS) - explanation and elaboration: a report of the ISPOR Health Economic Evaluation Publication Guidelines Good Reporting Practices Task Force. Value Health. 2013;16(2):231–50.CrossRefPubMed
11.
12.
13.
14.
15.
Group EQ. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy. 1990;16(3):199–208.CrossRef
16.
17.
Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–92.PubMed
18.
Hamilton BB, Granger CV. Disability outcomes following inpatient rehabilitation for stroke. Phys Ther. 1994;74(5):494–503.PubMed
19.
Beninato M, Gill-Body KM, Salles S, Stark PC, Black-Schaffer RM, Stein J. Determination of the minimal clinically important difference in the FIM instrument in patients with stroke. Arch Phys Med Rehabil. 2006;87(1):32–9.CrossRefPubMed
20.
Mihaylova B, Briggs A, O’Hagan A, Thompson SG. Review of statistical methods for analysing healthcare resources and costs. Health Econ. 2011;20(8):897–916.CrossRefPubMed
21.
Thompson SG, Barber JA. How should cost data in pragmatic randomised trials be analysed? British Med J. 2000;320(7243):1197.CrossRef
22.
Vickers AJ. Parametric versus non-parametric statistics in the analysis of randomized trials with non-normally distributed data. BMC Med Res Methodol. 2005;5(1):35.CrossRefPubMedPubMedCentral
23.
24.
Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, et al. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393.CrossRefPubMedPubMedCentral
25.
Nixon RM, Wonderling D, Grieve RD. Non‐parametric methods for cost‐effectiveness analysis: the central limit theorem and the bootstrap compared. Health Econ. 2010;19(3):316–33.CrossRefPubMed
26.
IBM Corp. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: USA IBM Corp; 2012.
27.
StataCorp. Stata Statistical Software: Release 12. College Station, TX: USA StataCorp LP; 2011.
28.
Hutubessy R, Chisholm D, Edejer TT. Generalized cost-effectiveness analysis for national-level priority-setting in the health sector. Cost Eff Resour Alloc. 2003;1(1):8.CrossRefPubMedPubMedCentral
29.
Stone PW, Chapman RH, Sandberg EA, Liljas B, Neumann PJ. Measuring costs in cost-utility analyses. Int J Technol Assess Health Care. 2000;16(01):111–24. doi:doi:null.CrossRefPubMed
30.
Briggs A, Fenn P. Confidence intervals or surfaces? Uncertainty on the cost‐effectiveness plane. Health Econ. 1998;7(8):723–40.CrossRefPubMed
31.
Jones CA, Beaupre LA, Johnston D, Suarez-Almazor ME. Total joint arthroplasties: current concepts of patient outcomes after surgery. Clin Geriatr Med. 2005;21(3):527–41.CrossRefPubMed
32.
Kwakkel G, Kollen B, Wagenaar R. Long term effects of intensity of upper and lower limb training after stroke: a randomised trial. J Neurol Neurosurg Psychiatry. 2002;72(4):473–9.PubMedPubMedCentral
33.
Porter ME. A strategy for health care reform—toward a value-based system. N Engl J Med. 2009;361(2):109–12.CrossRefPubMed
34.
van den Hout W, Tijhuis G, Hazes J, Breedveld F, Vlieland TV. Cost effectiveness and cost utility analysis of multidisciplinary care in patients with rheumatoid arthritis: a randomised comparison of clinical nurse specialist care, inpatient team care, and day patient team care. Ann Rheum Dis. 2003;62(4):308–15.CrossRefPubMedPubMedCentral
35.
36.
37.
van den Berg B, Brouwer WB, Koopmanschap MA. Economic valuation of informal care: An overview of methods and applications. Eur J Health Econ. 2004;5(1):36–45.CrossRefPubMed
38.
Andersson A, Levin L-Å, Emtinger BG. The economic burden of informal care. Int J Technol Assess Health Care. 2002;18(01):46–54.PubMed
39.
Dewey HM, Thrift AG, Mihalopoulos C, Carter R, Macdonell RA, McNeil JJ, et al. Cost of stroke in Australia from a societal perspective results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke. 2001;32(10):2409–16.CrossRefPubMed
40.
Fatovich D, Nagree Y, Sprivulis P. Access block causes emergency department overcrowding and ambulance diversion in Perth, Western Australia. Emerg Med J. 2005;22(5):351–4.CrossRefPubMedPubMedCentral
41.
42.
Shaw KD, Taylor NF, Brusco NK. Physiotherapy services provided outside of business hours in Australian hospitals: a national survey. Physiother Res Int. 2013;18(2):115–23.CrossRefPubMed
43.
Jones AM. The Elgar companion to health economics. Glos, United Kingdom: Edward Elgar Publishing; 2012.CrossRef
44.
Glick HA, Doshi JA, Sonnad SS, Polsky D. Economic evaluation in clinical trials. Oxford, United Kingdom: Oxford University Press; 2014.CrossRef
Metadata
Title
Is cost effectiveness sustained after weekend inpatient rehabilitation? 12 month follow up from a randomized controlled trial
Authors
Natasha Kareem Brusco
Jennifer J Watts
Nora Shields
Nicholas F Taylor
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-0822-3

Other articles of this Issue 1/2015

BMC Health Services Research 1/2015 Go to the issue

Research article

Use of GP services by patients with schizophrenia: a national cross-sectional register-based study

Research article

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study

Research article

What can dissaving tell us about catastrophic costs? Linear and logistic regression analysis of the relationship between patient costs and financial coping strategies adopted by tuberculosis patients in Bangladesh, Tanzania and Bangalore, India

Research article

Relationship between cardiovascular risk and lipid testing in one health care system: a retrospective cohort study

Research article

Disability Grant: a precarious lifeline for HIV/AIDS patients in South Africa

Research article

Understanding nurses’ and physicians’ fear of repercussions for reporting errors: clinician characteristics, organization demographics, or leadership factors?