Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial.
BMC Health Serv Res
; 22(1): 185, 2022 Feb 12.
Article
in En
| MEDLINE
| ID: mdl-35151285
ABSTRACT
BACKGROUND:
Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes.METHODS:
One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 11 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER).RESULTS:
The mean total costs of healthcare services was 3,281 in the CCT-SE group and 2,300 in TAU, informal care was 2,761 in CCT-SE and 3,591 in TAU, and productivity loss was 30,738 in CCT-SE and 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was 56 per day earlier back to work in the CCT-SE group. Given a threshold of 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of -561 (0.009*27,500-979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU.CONCLUSIONS:
Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective. TRIAL REGISTRATION ClinicalTrails.gov NCT03092713 .Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Rehabilitation, Vocational
/
Brain Injuries, Traumatic
Type of study:
Clinical_trials
/
Health_economic_evaluation
Limits:
Humans
Language:
En
Journal:
BMC Health Serv Res
Journal subject:
PESQUISA EM SERVICOS DE SAUDE
Year:
2022
Type:
Article
Affiliation country:
Norway