Cost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trial

Emilie Isager Howe; Nada Andelic; Silje C R Fure; Cecilie Røe; Helene L Søberg; Torgeir Hellstrøm; Øystein Spjelkavik; Heidi Enehaug; Juan Lu; Helene Ugelstad; Marianne Løvstad; Eline Aas

doi:10.1186/s12913-022-07585-3

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. 2022 Feb 12;22(1):185. doi: 10.1186/s12913-022-07585-3.

Authors

Emilie Isager Howe^{1

2}, Nada Andelic^{3

4}, Silje C R Fure^{3

4}, Cecilie Røe^{3

5

4}, Helene L Søberg^{3

6}, Torgeir Hellstrøm³, Øystein Spjelkavik⁷, Heidi Enehaug⁷, Juan Lu^{4

8}, Helene Ugelstad⁹, Marianne Løvstad^{10

11}, Eline Aas^{12

13}

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. emihow@ous-hf.no.
² Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway. emihow@ous-hf.no.
³ Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway.
⁴ Center for Habilitation and Rehabilitation Models and Services (CHARM), Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁵ Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
⁶ Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway.
⁷ The Work Research Institute, Oslo Metropolitan University, Oslo, Norway.
⁸ Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University, Richmond, USA.
⁹ Department of Vocational Rehabilitation, Norwegian Labour and Welfare Administration, Oslo, Norway.
¹⁰ Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.
¹¹ Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
¹² Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
¹³ Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway.

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 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 € 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 .

Keywords: Clinical trial; Health economics; Traumatic brain injury; Vocational rehabilitation.

Publication types

Randomized Controlled Trial

MeSH terms

Brain Injuries, Traumatic*
Cognition
Cost-Benefit Analysis
Humans
Quality-Adjusted Life Years
Rehabilitation, Vocational*

Associated data

ClinicalTrials.gov/NCT03092713