Economics of additional weekend rehabilitation

Submission note: A thesis submitted in total fulfilment of the requirements for the degree of Doctor of Philosophy by published work to the Department of Rehabilitation, Nutrition and Sport, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora.

Thesis with publications.

This thesis was a recipient of the Nancy Millis Award for theses of exceptional merit.

This thesis investigated the economic and clinical impact of a Saturday inpatient rehabilitation service. A systematic review of inpatient rehabilitation (Chapter 2) concluded that compared to usual care inpatient rehabilitation, a more intensive model of inpatient rehabilitation may improve patient outcomes at a reduced cost. Therefore, a randomised controlled trial investigating the economic and clinical impact of additional Saturday inpatient rehabilitation (physiotherapy and occupational therapy), on a sample of 996 patients, was conducted with 30 day, 6 and 12 month follow up. The economic evaluation from admission to 30 days following discharge (Chapter 3) found a likely cost saving per admission to the health service (AUD$1,673; 95%CI -271 to 3,618), in addition to improved patient function and quality of life. The incremental cost effectiveness ratio showed a saving of AUD$41,825 (95%CI -2,817 to 74,620) per quality adjusted life year gained and a saving of AUD$16,003 (95%CI -3,074 to 87,361) in achieving a minimal clinically important difference in functional independence. The likely cost saving was largely attributed to the observed reduction in length of stay (-2.9 days; 95%CI -6.5 to 0.7). The economic evaluation from admission to 12 months following discharge (Chapter 4) was from a health system perspective inclusive of national insurer and health service administrative data, as well as informal care and private costs. There were sustained improvements in patient function and quality of life. Cost saving from admission to 6 months was AUD$6,445 (95%CI 3,368 to 9,522) and from admission to 12 months was xiii AUD$6,325 (95%CI -4,081 to 16,730) per admission. Saturday rehabilitation had no impact on return to work (Chapter 5). In summary, there is a high degree of certainty that providing additional Saturday inpatient rehabilitation is cost effective from both a health service and health system perspective.