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dc.contributor.authorHowe, Emilie
dc.contributor.authorAndelic, Nada
dc.contributor.authorFure, Silje Christine Reistad
dc.contributor.authorRøe, Cecilie
dc.contributor.authorSøberg, Helene L.
dc.contributor.authorHellstrøm, Torgeir
dc.contributor.authorSpjelkavik, Øystein
dc.contributor.authorEnehaug, Heidi
dc.contributor.authorLu, Juan
dc.contributor.authorUgelstad, Helene
dc.contributor.authorLøvstad, Marianne
dc.contributor.authorAas, Eline
dc.description.abstractBackground: Traumatic brain injury (TBI) represents a fnancial burden to the healthcare system, patients, their families and society. Rehabilitation interventions with the potential for reducing costs associated with TBI are demanded. This study evaluated the cost-effectiveness of a randomized, controlled, parallel group trial that compared the effectiveness of a combined cognitive and vocational intervention to treatment as usual (TAU) on vocational outcomes. Methods: One-hundred sixteen participants with mild-to-moderate TBI were recruited from an outpatient clinic at Oslo University Hospital, Norway. They were randomized to a cognitive rehabilitation intervention (Compensatory Cognitive Training, CCT) and Supported Employment (SE) or TAU in a 1:1 ratio. Costs of CCT-SE and TAU, healthcare services, informal care and productivity loss were assessed 3, 6 and 12 months after study inclusion. Cost-effectiveness was evaluated from the difference in number of days until return to pre-injury work levels between CCT-SE and TAU and quality-adjusted life years (QALYs) derived from the EQ-5D-5L across 12 months follow-up. Cost-utility was expressed in incremental cost-effectiveness ratio (ICER). Results: The mean total costs of healthcare services was € 3,281 in the CCT-SE group and € 2,300 in TAU, informal care was € 2,761 in CCT-SE and € 3,591 in TAU, and productivity loss was € 30,738 in CCT-SE and € 33,401 in TAU. Costs related to productivity loss accounted for 84% of the total costs. From a healthcare perspective, the ICER was € 56 per day earlier back to work in the CCT-SE group. Given a threshold of € 27,500 per QALY gained, adjusting for baseline difference in EQ-5D-5L index values revealed a net monetary beneft (NMB) of € -561 (0.009*27,500–979) from the healthcare perspective, indicating higher incremental costs for the CCT-SE group. From the societal perspective, the NMB was € 1,566 (0.009*27,500-(-1,319)), indicating that the CCT-SE intervention was a cost-effective alternative to TAU. Conclusions: Costs associated with productivity loss accounted for the majority of costs in both groups and were lower in the CCT-SE group. The CCT-SE intervention was a cost-effective alternative to TAU when considering the societal perspective, but not from a healthcare perspective.en_US
dc.description.sponsorshipThis research was funded by The Research Council of Norway, Grant number 256689/H10.en_US
dc.relation.ispartofseriesBMC Health Services Research;22, Article number: 185 (2022)
dc.rightsNavngivelse 4.0 Internasjonal*
dc.subjectTraumatic brain injuriesen_US
dc.subjectHealth economicsen_US
dc.subjectClinical trialsen_US
dc.subjectVocational rehabilitationen_US
dc.titleCost-effectiveness analysis of combined cognitive and vocational rehabilitation in patients with mild-to-moderate TBI: results from a randomized controlled trialen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.rights.holder© The Author(s) 2022en_US
dc.source.journalBMC Health Services Researchen_US
dc.relation.projectNorges forskningsråd: 256689en_US
dc.relation.projectNorges forskningsråd: 272789en_US

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Navngivelse 4.0 Internasjonal
Except where otherwise noted, this item's license is described as Navngivelse 4.0 Internasjonal