The Importance of Perspective When Evaluating The Economic Value of Vocational Rehabilitation

Abstract

Objectives: The NICE reference case recommends economic evaluations take an NHS and Personal Social Services (PSS) perspective. This is appropriate if all of the associated costs and benefits are captured, however less so, when a proportion lie outside of healthcare. We aim to explore the importance of perspective in the FRESH trial. This trial assessed the feasibility of delivering a full scale trial evaluating the (cost) effectiveness of Vocational Rehabilitation (VR), an individualised return to work programme, amongst Traumatic Brain Injury patients in comparison to usual care, across three trauma centres in England. Methods: This feasibility study compared alternative methods of collecting and valuing resource use data, which included taking two perspectives: NHS and PSS, plus a societal perspective. Several methods were used to estimate time off work costs, for example using national average hourly wage rates compared to participant reported earnings, as well as valuing presenteeism through the Workers Productivity and Activity Impairment instrument compared to bespoke questions. Results: When societal costs were considered, such as government employment services, time off work and out of pocket costs, the broader costs accounted for 61.77% of total costs in the VR group, compared to 80.90% within usual care. Though these percentages varied according to methods used, they demonstrate that within any full-scale economic evaluation conducted, it is likely that the largest cost-drivers will occur using a societal perspective. Taking a broader perspective adds complexity to an evaluation in terms of appropriately capturing the data and in identifying sources of unit costs. Conclusions: Using a limited perspective where significant costs and benefits are believed to lie outside healthcare could lead to erroneous estimates of value for money and poor value from public funding. Further research is required to inform how such wider resource items should be measured and valued.