Cost-effectiveness of powered wheelchairs: findings of a study

This study surveyed a sample of 79 wheelchair users who had obtained powered wheelchairs from the National Health Service in an Italian Region in the period 2008-2013. The wheelchair prescriptions had been done on the basis of an assessment protocol agreed with the Local Health Authority. Follow-up interviews were carried out at the users' homes, in order to collect information about the wheelchair use and its effectiveness, usefulness and economic impact. The instruments used in the interviews included an introductory questionnaire (describing the wheelchair use), the QUEST (measuring the user's satisfaction), the PIADS (measuring the psychosocial impact, in terms of perceived changes in ability, adaptability and self-esteem), the FABS/M (detecting environmental facilitators and barriers) and the SCAI (estimating the economic impact). Overall, positive outcomes were detected for most users, especially in relation to their satisfaction and the psychosocial impact. A number of barriers were identified in various settings (at home, in public places, in natural spaces, in public transportation) that sometimes restrict the user mobility and thus may claim for corrective actions. Several environmental factors acting as facilitators were also identified. In relation to the economic impact, the provision of a powered wheelchair generated remarkable savings in social costs for most of the users, on average about 36.000 Euros per person on a projected 5-years span. This estimate results from the comparison between the social cost of the intervention (sum of the costs of all material and human resources involved in the provision and usage of the wheelchair) and the cost of non-intervention (the presumed social cost incurred in case no powered wheelchair had been provided and the user had to carry on with just a manual wheelchair). The study was also an opportunity to develop and try out a follow-up method that proved applicable within service delivery practice.