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 (95% CI: 447–597), Medium: £148 (76–217), Low: £36 (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.