Remote Multicomponent Rehabilitation and Cost-Effectiveness in Survivors of Critical Illness
Mandana Zanganeh, Brenda O’Neill, Judy M. Bradley, Bronwen Connolly, Julie Bruce, Martin Underwood, Mariam Ratna, Ranjit Lall, Chen Ji, Jill Costley, Rachel Clarke, Paul Dark, Orla Duffy, Penelope Firshman, Nigel D. Hart, Annette Henderson, Katherine Jones, Roger Kenyon, Darren Murphy, Gavin D. Perkins, Kerry Raynes, Ella Terblanche, Daniel F. McAuley, Jason Madan, , Jane Snell, Sinead O'Kane, Jonathan Weblin, Denise McFarland, Jane Hedley, Kate Tantam, Sarah Varga, Catherine Donnison, Jennifer Davies, Samantha Coetzee, Keeleigh Champman, Amy Arnold, Hannah Hayter, Isabel Gonzales, Julie North, Mandeep Phull, Eriko Morino, Deborah Paripoorani, Patricia Doble, Juan Martin-Lazaro, Charlotte Tai, Ruth Wood, Tracey Hodgkiss, Kathryn Birchall, Eva Hirst, Denise Skinner, Kayode Adeniji, Estefania Trues, Cheryl Graham, Francesca Compton, Nicholas Truman, Lynn McDonnell, Karthhika Jeyakumar, Bethan Gibson, Daniel Law, Alicia Waite, Rebecca Chadwick, Daniel Hansen, Elizabeth Howard, Sarah Howe, Zoe Van Willigen, Philip Duggleby, Anthony Rostron, Samantha Hagan, David McWilliams, Joanna Thomas, Ahmed Abdelaty, Valerie Page, Kirstin Geer, Suzahn Wilson, Martin Udberg, Anezka Pratley, Amy Charnock, Luke Ward, Ellen KnightsImportance
The cost-effectiveness of remote rehabilitation for survivors following critical illness after intensive care unit (ICU) care is unknown.
Objective
To evaluate the cost-effectiveness of remote multicomponent rehabilitation compared with standard care following discharge from hospital after an ICU admission.
Design, Setting, and Participants
This economic evaluation was conducted within a pragmatic, multicenter, assessor-blinded trial comparing remote rehabilitation delivered online with standard care after discharge from ICU from both National Health Service (NHS) and Personal Social Services (PSS) and societal perspectives over a 6-month time horizon. The trial was conducted from December 2022 to November 2025. The setting was 52 NHS hospitals in the United Kingdom. Participants were adults (aged ≥18 years) within 12 weeks of discharge from hospital that included an ICU admission for critical illness, requiring mechanical ventilation for 48 hours or longer.
Interventions
A remotely delivered rehabilitation program or standard care.
Main Outcomes and Measures
Costs including using questionnaires and microcosting approach (in 2024 UK pounds sterling) and quality-adjusted life-years (QALYs), derived directly from trial data, were calculated per group and reported in terms of incremental cost per QALY gained.
Results
A total of 429 participants (245 men [57%]; mean [SD] age, 55.4 [13.9] years) were enrolled, including 231 (54%) in the intervention group and 198 (46%) in the standard group. From a UK NHS-PSS perspective, the rehabilitation intervention was associated with increased mean costs (£1250; 95% CI, £562-£1938) and QALYs (0.023; 95% CI, 0.007-0.040) per participant, compared with the standard care group. Incremental cost-effectiveness ratio (ICER) was £54 034 per QALY. The probability of rehabilitation intervention being cost-effective was 3% and 11% at UK willingness-to-pay thresholds of £20 000 and £30 000 per QALY, respectively. The intervention was cost-effective for patients with mechanical ventilation for 7 days or less (ICER, £21 476 per QALY) or if a societal perspective was adopted (ICER, £6341 per QALY).
Conclusions and Relevance
In this economic analysis, among ICU survivors overall, a remotely delivered multicomponent rehabilitation program was not cost-effective from a UK NHS-PSS perspective. Cost-effectiveness was more favorable from a societal perspective and for patients receiving mechanical ventilation for 7 days or less. For rehabilitation interventions to be both clinically and cost-effective a precision medicine approach to medical and psychosocial health care interventions is needed once patients are home from hospital.