Cost-efficiency of longer-stay rehabilitation programmes: can they provide value for money?

To examine the cost-efficiency of longer stay rehabilitation in patients with complex neurological disabilities.

Longitudinal cohort analysis of consecutive admissions to a specialized in-patient rehabilitation unit.

patients who were highly dependent on admission (NPDS > or = 25) and had a length of stay > 125 days. Serial changes in dependency and care costs were measured by the Northwick Park Dependency and Care Needs Assessment (NPDS/NPCNA), which provides a generic estimation of dependency, care hours and weekly cost of continuing care in the community.

Of 410 admissions over 5 years, 51 met the case-selection criteria - mean age 39 +/- 17 years, male:female ratio 2:1. The mean length of stay (LOS) was 184 +/- 56 days (max 312). Between 4 months and discharge (mean 58 +/- 56 days later) significant changes were seen in dependency (t = 4.8, p < 0.0001) and care costs (t = 2.0, p < 0.05). The mean additional cost of rehabilitation beyond 4 months ( pound sterling 16 766 +/- 17 334) would be offset by the mean weekly savings in cost of care within 36 months. The two cases who stayed > 300 days are presented in more detail.

The additional investment in longer-stay rehabilitation in this group of complex patients was offset relatively quickly by long-term savings in the cost of care.