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

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.