Cost-effectiveness of (sub)acute rehabilitation services for spinal cord injury: a retrospective cohort analysis

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Background The global rise in disability and healthcare spending has intensified the need for cost-effective rehabilitation. Spinal cord injury/disease (SCI/D), though relatively rare, is associated with high costs and complex care needs, making it an ideal condition to study efficient resource allocation in rehabilitation. Methods This retrospective observational study included 375 patients with SCI/D from a Swiss SCI centre. Outcome of rehabilitation was measured using the Spinal Cord Independence Measure III (SCIM III). Latent class analysis identified three patient profiles. Cost-effectiveness was assessed by relating total costs to functional improvement, with logistic regression identifying predictors of efficient rehabilitation. Results Three distinct patient profiles showed significant differences in costs, service utilisation, and functional gains. Average efficiency—defined as achieving above-average functional improvement at below-average cost— was estimated at ΔSCIM III of 57, with a total cost of 118,000 Swiss francs. Efficient rehabilitation was most likely among patients. in profiles 1 and 2, younger with fewer comorbidities and with severe injuries. Conclusions Patient segmentation enables targeted, equitable resource allocation in rehabilitation. Efficiency varies by patient profile, and even modest gains may be meaningful for severely impaired patients. A stratified cost-effectiveness evaluation is vital for policy and practice.

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