Article

OBJECTIVES: To report if there is a difference in costs from a societal
perspective between adults receiving rehabilitation in an inpatient
rehabilitation setting versus an alternative setting. If there are cost
differences, to report whether opting for the least expensive program setting
adversely affects patient outcomes. DATA SOURCES: Electronic databases from the
earliest possible date until May 2011. All languages were included. STUDY SELECTION: Multiple reviewers identified randomized controlled trials with a full
economic evaluation that compared adult inpatient rehabilitation with an
alternative. There were 29 included trials with 6746 participants. DATA
EXTRACTION: Multiple observers extracted data independently. Trial appraisal
included a risk of bias assessment and a checklist to report the strength of the
economic evaluation. DATA SYNTHESIS: Results were synthesized using standardized
mean differences (SMDs) and meta-analyses for the primary outcome of cost. The
Grading of Recommendations Assessment, Development, and Evaluation was applied to
assess for risk of bias across studies for meta-analyses. There was high-quality
evidence that cost was significantly reduced for rehabilitation in the home
versus inpatient rehabilitation in a meta-analysis of 732 patients poststroke
(pooled SMD [delta]=-.28; 95% confidence interval [CI], -.47 to -.09), without
compromise to patient outcomes. Results of individual trials in other patient
groups (orthopedic, rheumatoid arthritis, and geriatric) receiving rehabilitation
in the home or community were generally consistent with the meta-analysis. There
was moderate quality evidence that cost was significantly reduced for inpatient
rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463
patients poststroke (delta=.31; 95% CI, .15-.48), with improvement to patient
outcomes. These results were not replicated in 2 individual trials with a
geriatric and a mixed cohort, where costs did not differ between general acute
care and inpatient rehabilitation. Three of the 4 individual trials, inclusive of
a stroke or orthopedic population, reported less cost for an intensive inpatient
rehabilitation program compared with usual inpatient rehabilitation. Sensitivity
analysis included a health service perspective and varied inflation rates with no
change to the significant findings of the meta-analyses. CONCLUSIONS: Based on
this systematic review and meta-analyses, a single rehabilitation service may not
provide health economic benefits for all patient groups and situations. For some
patients, inpatient rehabilitation may be the most cost-effective method of
providing rehabilitation; yet, for other patients, rehabilitation in the home or
community may be the most cost-effective model of care.
To achieve cost-effective
outcomes, the ideal combination of rehabilitation services and patient inclusion
criteria, as well as further data for nonstroke populations, warrants further research.
CI - Copyright (c) 2014 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS