Cost-effectiveness of the My Therapy self-directed therapy program for rehabilitation patients: A stepped wedge cluster randomised trial.

Abstract

ObjectiveTo determine if the My Therapy self-management program could be implemented without increasing the rehabilitation admission cost, from a health service perspective.DesignEconomic evaluation, including a cost-effectiveness analysis.SettingAustralian rehabilitation wards (n = 9).ParticipantsRehabilitation inpatients with any diagnosis.InterventionMy Therapy: a self-directed therapy program shown to increase daily inpatient rehabilitation participation dosage time by 38%.Main MeasuresOutcomes included cost (rehabilitation admission and all-cause 30-day readmissions), and effect (minimal clinically important difference in functional independence (FIM^TM), and quality-adjusted life years (EQ-5D-5L)), to estimate incremental cost-effectiveness ratios (ICERs).ResultsThere were 2363 participants, with a mean age of 77 (SD 13) years, 62% female, and 27% with cognitive impairment. My Therapy costs $5 (SD $2) per patient/day to implement, excluding opportunity costs. Estimated differences in effect were non-significant for the proportion of participants achieving a minimal clinically important difference in function (control 31%, intervention 36%; OR: 1.08, 95% CI: 0.77, 1.53), and quality-adjusted life years (mean difference -0.01, 95% CI: -0.04 to 0.02). Estimated differences in cost were also non-significant (OR: 1.06, 95% CI: 0.97, 1.16). ICERs were also non-significant. Post hoc, it was determined that the cost/minute of daily therapy participation was $14/minute for control and $11/minute for intervention conditions.ConclusionsThe My Therapy self-management program was implemented without increasing rehabilitation admission and all-cause 30-day readmission costs. However, clinical differences were not detected. There may have been a small reduction in cost/minute for daily therapy participation.