Head injury rehabilitation in the U.K.: an economic perspective

The human and societal costs as a result of traumatic brain injury (TBI) are extensive with approximately 200-300/100,000 of the population requiring hospitalisation each year in the U.K. Advances in neurosurgical management have meant that more people sustaining head injuries are surviving. The need for rehabilitation programmes for these individuals is therefore ever increasing. While in the U.S.A. rehabilitation programmes for TBI patients are well established, in the U.K. the provision of such services is patchy and varies widely in different localities. The belated response to the rehabilitation needs of this group of individuals in the U.K. has coincided with an increased awareness of the economic efficiency of health care provision. This paper critically reviews published studies looking at the economics of rehabilitation services for brain injured patients. No studies in the U.K. were identified and all the sources discussed are from the U.S.A. The methodological guidelines underlying economic appraisal of health care are summarised and the studies assessed to determine the extent to which they fulfil these guidelines. The paper concludes that most studies purporting to provide evidence of cost-effectiveness did not include appropriate data, nor followed the methodological guidelines allowing such claims to be made. Some recommendations for future research are presented.