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Rehabilitation (Stuttg). 2004 Apr;43(2):83-9.

[Comparison of costs-of-illness in a year before and after inpatient and outpatient rehabilitation in persons with spinal disorders].

[Article in German]

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Abteilung Rheumatologie, Medizinische Hochschule Hannover.


The present economic analyses of orthopaedic inpatient and outpatient rehabilitation (IPR resp. OPR) focus but on the evaluation of the expenses from the cost carrier's perspective. Lower intervention costs were related to OPR, whereas comparable social and clinical outcome was achieved. Comprehensive assessment of the economic consequences (resource utilization and lost productivity) of low back pain have not been performed up to now. Therefore, as part of a prospective follow-up study (1) a comparison of overall cost-of-illness and cost components 12 months prior and after IPR and OPR, respectively, was carried out in patients with low back pain and (2) the relative changes of these cost components were compared in a full-cost-analysis from a societal perspective. A total of 150 matched pairs (SR and AR) were followed prospectively over 12 months. Disease related costs in the year prior to the intervention were evaluated retrospectively. Prior to IPR and OPR overall costs amounted to 7010 and 7710 Euro, respectively, per person and year in patients with low back pain. As the main cost component of overall costs, sick leave (SL) periods account for 74% (IPR) and 76% (OPR), respectively. Inpatient costs represent the main component of direct costs. In the year after the intervention the costs due to sick leave periods still represent the major cost component (46 and 52%, resp.) of overall costs (3370 and 3600 Euro, resp.). Disease related cessation of work including work disability accounts for about 10% of productivity costs after IPR and OPR. Indirect costs still make up for the major part of overall costs (58 and 62%, resp.). No differences of cost components and their relative changes can be seen between patients participating in IPR and OPR, respectively, within both time frames. The comparison of overall costs in the 12 months before and after IPR and OPR reveals a cost reduction of 52% (IPR) and 53% (OPR), resp. This decrease of costs is mainly related to the reduction of SL periods, though costs due to inpatient treatment decrease as well. Summarizing, the present full-cost-analysis from a societal perspective shows no differences of cost components and cost changes between orthopaedic IPR and OPR in the 12 months prior to and after the intervention. Comprehensive cost-analyses reveal no obstacles for further implementation of OPR in the treatment of low back pain. Future development and diversification of rehabilitation measures should aim at evaluating real resource consumption during the intervention in detail as a basis for further allocational decision making.

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