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, Mendwas Dzingina, Robert Shavelle and 3 others
PMID 30801440WHAT IT FOUND
Specialist inpatient rehabilitation for severe traumatic brain injury was associated with large estimated reductions in ongoing care costs, but this observational cost analysis assumed gains would persist without rehabilitation.
Key findings
01Patients admitted for specialist rehabilitation showed significant improvements in independence and estimated reductions in dependency, care hours, and weekly care costs between admission and discharge.
02The cost analysis estimated that ongoing care savings could offset rehabilitation costs and generate positive net life-time savings for higher-functioning groups, while patients remaining in permanent vegetative state had almost no cost savings.
03The analysis assumed that without rehabilitation care costs would remain at admission levels and that independence achieved during rehabilitation would be sustained after discharge.
STILL TO COME
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What it does not show
The study was observational, so it cannot show that rehabilitation caused the savings. It assumed that without rehabilitation care costs would stay at admission levels, and that independence gained would continue after discharge. The life-expectancy analysis used only a subset with complete disability and care-need data, so selection bias remains. The analysed subset was more dependent and stayed longer than the average patient, which may affect generalisability. Cost estimates depend on a care-needs algorithm, tariff assumptions, and discounting choices. Patients admitted only for consciousness assessment were included in some analyses, and their exclusion changed the savings estimates.
Declared interests
The UKROC database was funded by a UK National Institute for Health Research research program and is commissioned by NHS England; the supplied text does not report author conflicts of interest.
The easy way to misread this
Do not conclude that specialist rehabilitation caused these savings; this observational cost analysis assumed care costs would remain unchanged without rehabilitation and that discharge independence would be sustained.