Cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis: A multicentre prospective cohort analysis of the UK Rehabilitation Outcomes Collaborative national clinical dataset for rehabilitation centres in England

Background Rehabilitation is effective for multiple sclerosis, but is it value for money? Objectives To evaluate functional outcomes, care needs and cost-efficiency of specialist inpatient rehabilitation for adults with multiple sclerosis (MS). Methods A multicentre cohort study of prospectively collected clinical data from the UK Rehabilitation Outcomes Collaborative national clinical database. Data included all adults with MS (n=1007) admitted for specialist inpatient (Level 1 or 2) rehabilitation in England, 2010-2018. Outcome measures Dependency/care needs: Northwick Park Dependency Scale/Care Needs Assessment, Functional independence: UK Functional Assessment Measure (UK FIM+FAM). Cost-efficiency. Patients were analysed in three dependency groups (High/Medium/Low). Results All groups showed significant reduction in dependency between admission and discharge on all measures (paired t-tests: p<0.001). Mean reduction in care costs/week was greatest in the most dependent patients: High: 519 pound (95% CI: 447-597), Medium: 148 pound (76-217), Low: 36 pound (12-83). Despite longer stays, time taken to offset the cost of rehabilitation was shortest in the most dependent patients: High: 12.9 (12.0-14.1) months; Medium: 29.3 (21.3-51.8); Low: 76.8 (0-36.1). Item-level changes corresponded with clinical experience. Conclusions Specialist rehabilitation provided good value for money in patients with MS, yielding improved outcomes and substantial savings in ongoing care costs, especially in high-dependency patients.