Research Reports - Cost-effectiveness analysis of an early-initiated, continuous chain of rehabilitation after severe traumatic brain injury

J Neurotrauma. 2014 Apr 10

Andelic N(1), Ye J, Tornas S, Roe C, Lu J, Bautz-Holter E, Moger T,
Sigurdardottir S, Schanke AK, Aas E

The aim of this study is to estimate the long-term cost-effectiveness of two
different rehabilitation trajectories after severe traumatic brain injury (sTBI).
A decision tree model compared hospitalization costs, health effects and
incremental cost-effectiveness ratios (ICER) of a continuous chain versus a
broken chain of rehabilitation. The expected costs were estimated by the
reimbursement system using diagnosis-related group (DRG), and based on point
estimates of the Disability Rating Scale (DRS); the health effects were measured
by means of area under the curve (AUC). The incremental health benefit was
estimated as the difference in the AUCs between the chains. Lower values on the
DRS scale indicate better health; thus, smaller AUCs were preferred. The modeled
population was a cohort of 59 patients with sTBI (30 in continuous chain; 29 in
broken chain) with 6-weeks, 1- and 5-years post-injury follow-ups. Regarding the
DRS estimates, 5-year AUCs were 19.40 (continuous chain) and 23.46 (broken
chain). Across 5 years, the continuous chain of rehabilitation had lower costs
and better health effects. By replacing the broken chain with the continuous
chain, NOK 37.000 could be saved and 4.06 DRS points gained. By means of
probabilistic sensitivity analysis, the majority of ICER estimates (67% of the
Monte Carlo simulations) indicated that a continuous chain of rehabilitation was
less costly and more effective. These findings indicate that the trajectory of
continuous rehabilitation represents a dominant strategy in that it reduces costs
and improves outcomes after sTBI under reasonable assumptions.

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