Evaluating rehabilitation using cost-consequences analysis: an example in Parkinson's disease.

OBJECTIVE

To use cost-consequences analysis to evaluate rehabilitation, and to discuss some practical limitations.

DESIGN

Case study of a cost-consequences analysis.

SETTING

Day hospital.

SUBJECTS

People with Parkinson's disease without major cognitive loss, and their carers.

INTERVENTION

A programme of multidisciplinary rehabilitation, delivered for one day per week over six weeks, and including 2 h of individual therapy (physical, occupational, speech and language, specialist nurse) and group activities on each occasion.

COSTS

direct and overhead costs of treatment; participant travel.

CONSEQUENCES

patient outcomes (mobility, speech and language, disability, psychological well-being, health-related quality of life); carer outcomes (psychological well-being, health-related quality of life, strain); social service utilization; satisfaction.

RESULTS

In this example the main costs were facility's overheads and hospital-provided transport. The consequences of the intervention were improved immediate outcomes for patients that diminished over four months, discovery of unmet social services need, high satisfaction. No benefits for carers were observed.

CONCLUSION

A cost-consequences analysis provides a clear descriptive summary for decision-makers that is easier to interpret than cost-effectiveness, cost-utility and cost-benefit analysis. It is a useful technique in rehabilitation research where multiple outcomes and several perspectives (health service, patient, carer) are relevant. However limitations remain: it is difficult to capture all consequences because of data deficiencies and long-term effects; evaluations of individual interventions are partial and do not guarantee economic rationality; local studies may not be generalizable; fixed protocols impede the evaluation of alternative service configurations.