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Cost effectiveness of integrated care in patients with acquired brain injury


Áine M Carroll ,

National Rehabilitation Hospital, IE
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Marie Therese Cooney

St Vincent's University Hospital, Dublin, IE
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Introduction: Integrated care and Rehabilitation following acquired brain injury improves health outcomes, reduces disability, and improves quality of life. We assessed the cost effectiveness of inpatient rehabilitation after brain injury in individuals with brain injury admitted to the Irish national tertiary specialist rehabilitation centre in 2011.

The brain injury team – which consists of a specialist multidisciplinary team including Doctors, nurses, physiotherapists, occupational therapists, speech and language therapists, psychologists, clinical nutritionists, pharmacists and medical social workers – work with patients and their families and carers to achieve the best possible outcome for the patient with a person centred inpatient programme tailored to meet each patient's individual needs.

Methods: The study included all patients discharged between 1 January

2011 and 31 December 2011 from the NRH Brain Injury Programme under one of the NRH rehabilitation consultants(AC).Patients’ score on the Disability Rating Scale (DRS) was recorded on admission and at discharge after intensive inpatient rehabilitation. Cost savings attributed to the rehabilitation programme were calculated as the difference between direct care costs on admission and discharge. Direct costs of care were calculated as the weekly cost of the care-assistant hours required to care for patients on the basis of their level of disability or daily nursing-home bed cost when this was required.

Results: Of 63 patients, complete DRS information for admission and discharge was available for 41. DRS scores, and therefore average levels of functioning, differed significantly at admission (2.3, between mildly and moderately dependent) and discharge (1.1, independent in special environments, p<0.01).

Average weekly care costs fell from €629 to €242, with costs recouped within 30 months.

Discussion: Although the cost of inpatient rehabilitation in this group is expensive

initially, in the medium term these costs are covered by the

savings in care costs. Ceiling and floor effects of dependency scales can result in underestimation of cost-effectiveness of rehabilitation.Thus, substantial savings result from inpatient rehabilitation, and these savings could have been greater had we considered also the economic benefit of enabling patients to return to employment.

Limitations: A randomised controlled trial of rehabilitation versus no rehabilitation would provide more information but would generate an ethical dilemma, in that it would necessitate denying treatment, which is considered standard and has sufficient evidence to support its use, to a group of individuals.

We have looked only at financial savings in this study. An analysis of gains in quality of life would clearly provide a more accurate reflection of the value of inpatient rehabilitation.

Conclusion: This is the first analysis of the cost effectiveness of inpatient rehabilitation in an Irish setting. We have shown that, on average, the cost of inpatient rehabilitation is covered by the savings resulting from reductions in dependency within 30 months. Inpatient rehabilitation seems to be most cost effective in individuals with brain injury who are markedly dependent on admission, with only 15.6 months required to cover the inpatient cost in this group. After this time, calculated savings of over €50,000 per patient annually can be expected.

How to Cite: Carroll ÁM, Cooney MT. Cost effectiveness of integrated care in patients with acquired brain injury. International Journal of Integrated Care. 2017;17(3):A152. DOI:
Published on 11 Jul 2017.


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