The Value of Nonpharmacological Interventions for People With an Acquired Brain Injury: A Systematic Review of Economic Evaluations

• Published in: Value in health Vol. 25; no. 10; pp. 1778 - 1790
• Main Authors: Mitchell, Eileen, Ahern, Elayne, Saha, Sanjib, McGettrick, Grainne, Trépel, Dominic
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2022
• Subjects: acquired brain injury; economic evaluation; Health Care Service and Management, Health Policy and Services and Health Economy; Health Sciences; Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi; Hälsovetenskap; Medical and Health Sciences; Medicin och hälsovetenskap; nonpharmacological interventions; stroke; systematic review; economic evaluation; systematic review; stroke; acquired brain injury; nonpharmacological interventions
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2022.03.014

Acquired brain injury (ABI) has long-lasting effects, and patients and their families require continued care and support, often for the rest of their lives. For many individuals living with an ABI disorder, nonpharmacological rehabilitation treatment care has become increasingly important care component and relevant for informed healthcare decision making. Our study aimed to appraise economic evidence on the cost-effectiveness of nonpharmacological interventions for individuals living with an ABI. This systematic review was registered in PROSPERO (CRD42020187469), and a protocol article was subject to peer review. Searches were conducted across several databases for articles published from inception to 2021. Study quality was assessed according the Consolidated Health Economic Evaluation Reporting Standards checklist and Population, Intervention, Control, and Outcomes criteria. Of the 3772 articles reviewed 41 publications met the inclusion criteria. There was a considerable heterogeneity in methodological approaches, target populations, study time frames, and perspectives and comparators used. Keeping these issues in mind, we find that 4 multidisciplinary interventions studies concluded that fast-track specialized services were cheaper and more cost-effective than usual care, with cost savings ranging from £253 to £6063. In 3 neuropsychological studies, findings suggested that meditated therapy was more effective and saved money than usual care. In 4 early supported discharge studies, interventions were dominant over usual care, with cost savings ranging from £142 to £1760. The cost-effectiveness evidence of different nonpharmacological rehabilitation treatments is scant. More robust evidence is needed to determine the value of these and other interventions across the ABI care pathway. •This is the first systematic review of economic evaluations to comprehensively considered acquired brain injury (ABI) and the value of different categories of interventions. Different forms of brain injury infer varying economic consequence, and rehabilitation is a complex intervention that requires varying resources. To date, no review has mapped contributions of international research toward improving the economic implications of ABI. Studies to date have been unsystematic in their identification and have been dominated by a focus on stroke, which may have limited relevance to service providers trying to plan how best to plan allocate their limited resources to provide rehabilitation services.•Comprehensively reviewing all known cost-effectiveness analysis of nonpharmacological interventions targeting ABI, this systematic review has mapped international research aiming to improving the economic implications of ABI. Searching for all economic studies published since inception, this review illustrates which countries have contributed to knowledge, provided expert and objective appraisal of methodological quality of the evidence, and, importantly, points to the paucity of research investment by many high-income countries. In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, this review conducted a comprehensive literature searching and adherences to the most rigorous methodologies. Based on expert and objective appraisal, this review recommends greater increased investment in economic research of brain injury, signpost areas for improvement to methodological quality, and calls for routine inclusion of an economic perspective in multidisciplinary research of rehabilitation.•Over the last 2 decades, research into what rehabilitation resources might improve economic consequences of brain injury has been limited. Three-quarters of all economic evaluations in brain injury rehabilitation have been conducted in just 5 countries (United Kingdom [36%], Australia [9%], Canada [9%], The Netherlands [9%], and United States [9%]). Despite the high incidence of ABI and limited resources in low- and middle-income countries, there are very few economic studies (10%). This review call to the research community (for greater collaboration with economists), to policy makers, researcher funders, and other stakeholder (for requiring sound economic evidence to inform allocation of resources), and to health economists (to consider quality standards highlighted by this review).