학술논문
Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial
traumatic brain injury
traumatic brain injury
Document Type
Report
Author
Source
BMC Health Services Research. February 12, 2022, Vol. 22 Issue 1
Subject
Language
English
ISSN
1472-6963
Abstract
Author(s): Emilie Isager Howe[sup.1,2] , Nada Andelic[sup.1,3] , Silje C R Fure[sup.1,3] , Cecilie Rae[sup.1,2,3] , Helene L Saberg[sup.1,4] , Torgeir Hellstram[sup.1] , Øystein Spjelkavik[sup.5] , Heidi Enehaug[sup.5] , Juan [...]
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 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). Results The mean total costs of healthcare services was [euro] 3,281 in the CCT-SE group and [euro] 2,300 in TAU, informal care was [euro] 2,761 in CCT-SE and [euro] 3,591 in TAU, and productivity loss was [euro] 30,738 in CCT-SE and [euro] 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was [euro] 56 per day earlier back to work in the CCT-SE group. Given a threshold of [euro] 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of [euro] -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 [euro] 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. Keywords: Traumatic brain injury, Health economics, Clinical trial, Vocational rehabilitation
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 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). Results The mean total costs of healthcare services was [euro] 3,281 in the CCT-SE group and [euro] 2,300 in TAU, informal care was [euro] 2,761 in CCT-SE and [euro] 3,591 in TAU, and productivity loss was [euro] 30,738 in CCT-SE and [euro] 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was [euro] 56 per day earlier back to work in the CCT-SE group. Given a threshold of [euro] 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary benefit (NMB) of [euro] -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 [euro] 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. Keywords: Traumatic brain injury, Health economics, Clinical trial, Vocational rehabilitation