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J Head Trauma Rehabil. 2019 Feb 15. doi: 10.1097/HTR.0000000000000473. [Epub ahead of print]

Estimated Life-Time Savings in the Cost of Ongoing Care Following Specialist Rehabilitation for Severe Traumatic Brain Injury in the United Kingdom.

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Department of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative care, Cicely Saunders Institute, King's College London, London, UK (Drs Turner-Stokes and Dzingina); UK Rehabilitation Outcomes Collaborative, Regional/Hyper-acute Rehabilitation Unit, Northwick Park Hospital, Harrow, Middlesex, UK (Dr Turner-Stokes, Messrs Bill and Sephton, and Ms Williams); and Life Expectancy Project, San Francisco, California (Dr Shavelle). All UK authors are employed by the NHS and/or King's College London, which may cite this article as part of their research evaluation processes, including the UK Research Excellence Framework.



To evaluate cost-efficiency of rehabilitation following severe traumatic brain injury (TBI) and estimate the life-time savings in costs of care.


TBI patients (n = 3578/6043) admitted to all 75 specialist rehabilitation services in England 2010-2018.


A multicenter cohort analysis of prospectively collated clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database.


Primary outcomes: (a) reduction in dependency (UK Functional Assessment Measure), (b) cost-efficiency, measured in time taken to offset rehabilitation costs by savings in costs of ongoing care estimated by the Northwick Park Dependency Scale/Care Needs Assessment (NPDS/NPCNA), and (c) estimated life-time savings.


The mean age was 49 years (74% males). Including patients who remained in persistent vegetative state on discharge, the mean episode cost of rehabilitation was £42 894 (95% CI: £41 512, £44 235), which was offset within 18.2 months by NPCNA-estimated savings in ongoing care costs. The mean period life expectancy adjusted for TBI severity was 21.6 years, giving mean net life-time savings in care costs of £679 776/patient (95% CI: £635 972, £722 786).


Specialist rehabilitation proved highly cost-efficient for severely disabled patients with TBI, despite their reduced life-span, potentially generating over £4 billion savings in the cost of ongoing care for this 8-year national cohort.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

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