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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.117 SNIP: 0.228 CiteScore™: 0.17

ISSN Print: 0896-2960
ISSN Online: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v10.i4.30
pages 359-367

Cost-Effectiveness of Rehabilitation After Spinal Cord Injury

Diana D. Cardenas
University of Washington, Department of Rehabilitation Medicine, Seattle, WA
Jason N. Doctor
University of Washington, Department of Rehabilitation Medicine, Seattle, WA

ABSTRACT

Spinal cord injury is associated with significant disability and enormous costs as medical technology and life expectancies improve. This review describes the growing body of evidence for cost-effectiveness of rehabilitation in spinal cord injury. The objective of cost-effectiveness research is to help decision-makers allocate resources for healthcare in such a way that health for a given population is optimized. Cost-effectiveness analysis involves comparing a status quo intervention to an alternative treatment to determine if the alternative is more cost-effective than the standard. In most industrialized countries rehabilitation is an established "standard of care" intervention after spinal cord injury. Therefore, rehabilitation is not offered as an alternative to some other status quo intervention. Rehabilitation involves multiple treatment components and multiple disciplines. Individual attention to specific interventions and specific aspects of outcome is necessary in cost-effectiveness analysis of rehabilitation after spinal cord injury. For the evaluation of rehabilitation programs, a quality-adjusted life years approach is preferable to cost-effectiveness outcomes measurement that involves only the study of years of life lived. Studies of devices to improve function such as sacral anterior root stimulators and intrathecal baclofen pumps are the best examples of cost-effectiveness analysis found in the literatures. Comparisons of acute care and initial rehabilitation of the patient with spinal cord injury admitted to specialized spinal cord injury systems have compared treatments over differing time periods that suggest that early referral to a specialized model center reduces length of stay, cost, and medical complications. Like most areas of medicine, the study of cost-effectiveness of rehabilitation treatments after a spinal cord injury is still in the early stages of development. Future studies should strive to follow published guidelines such as those described by the panel convened in 1993 by the U.S. Public Health Service. Spinal cord injury is not as common as many other types of disabling injuries and diseases, but its costs are enormous and increasing as medical technology and life expectancies improve. In 1992, according to DeVivo, aggregate costs of new cases of spinal cord injury were estimated to be $7.2 billion per year, one-third the cost of stroke. So, despite an incidence of new spinal cord injuries of only about 40 cases per million persons per year in the U.S., spinal cord injury uses a disproportionate piece of the health-care dollar. Efforts to help reduce costs while assuring quality of care are important. This review examines the growing body of evidence for cost-effectiveness of rehabilitation in SCI.


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