Cost-effectiveness of the My Therapy self-directed therapy program for rehabilitation patients: A stepped wedge cluster randomised trial

Objective: To determine if the My Therapy self-management program could be implemented without increasing the rehabilitation admission cost, from a health service perspective. Design: Economic evaluation, including a cost-effectiveness analysis. Setting: Australian rehabilitation wards (n = 9). Participants: Rehabilitation inpatients with any diagnosis. Intervention: My Therapy: a self-directed therapy program shown to increase daily inpatient rehabilitation participation dosage time by 38%. Main Measures: Outcomes included cost (rehabilitation admission and all-cause 30-day readmissions), and effect (minimal clinically important difference in functional independence (FIM^TM), and quality-adjusted life years (EQ-5D-5L)), to estimate incremental cost-effectiveness ratios (ICERs). Results: There were 2363 participants, with a mean age of 77 (SD 13) years, 62% female, and 27% with cognitive impairment. My Therapy costs $5 (SD $2) per patient/day to implement, excluding opportunity costs. Estimated differences in effect were non-significant for the proportion of participants achieving a minimal clinically important difference in function (control 31%, intervention 36%; OR: 1.08, 95% CI: 0.77, 1.53), and quality-adjusted life years (mean difference −0.01, 95% CI: −0.04 to 0.02). Estimated differences in cost were also non-significant (OR: 1.06, 95% CI: 0.97, 1.16). ICERs were also non-significant. Post hoc, it was determined that the cost/minute of daily therapy participation was $14/minute for control and $11/minute for intervention conditions. Conclusions: The My Therapy self-management program was implemented without increasing rehabilitation admission and all-cause 30-day readmission costs. However, clinical differences were not detected. There may have been a small reduction in cost/minute for daily therapy participation.