Abstract
BackgroundTraumatic 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.MethodsOne-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 1:1 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).ResultsThe 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.ConclusionsCosts 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 registrationClinicalTrails.gov NCT03092713.
Highlights
Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society
The trial was conducted at a specialized TBI outpatient clinic at Oslo university hospital (OUH), Norway, where patients were randomised to a group-based compensatory cognitive training intervention and individualized supported employment (CCT-Supported Employment (SE)) or individualized outpatient treatment provided by a multidisciplinary team (TAU) in a 1:1 ratio
The results revealed a total cost difference of approximately € 550 (p < 0.001) where the treatment as usual (TAU) treatment was associated with significantly lower costs than the Compensatory cognitive training (CCT)-SE intervention
Summary
Traumatic brain injury (TBI) represents a financial burden to the healthcare system, patients, their families and society. It is widely recognized that traumatic brain injury (TBI) represents a substantial economic burden to the healthcare system, in addition to the patients, their families and society [1]. There is some evidence to suggest that rehabilitation interventions such as multidisciplinary inpatient- and home-based rehabilitation, cognitive-behavioural therapy, cognitive rehabilitation with particular emphasis on compensatory strategies, and work-directed interventions in combination with education/coaching are likely to produce improved care efficiency and RTW, in addition to substantial cost savings [3,4,5,6]. A prospective RCT found that a specialist multidisciplinary domiciliary outreach team showed increased independence and fewer care needs, suggesting that specialist community-based rehabilitation in the late phase after TBI resulted in significant long-term cost savings [8]. In a recent study from the UK, group-based memory rehabilitation with 10 weekly sessions of a manualised memory rehabilitation programme did not demonstrate cost-effectives for people with TBI living in the community [9]
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