A cost analysis of specialist inpatient neurorehabilitation services in the UK

Objective: To determine the range and variation in costs and service characteristics between different levels of specialist neurorehabilitation services in England, and to determine key predictors of service costs. Design: A retrospective analysis of service costs, staffing and activity levels, with comparison across service types. Setting: Specialist neurorehabilitation services ( n = 17) from different areas of England, were divided into three types according to predefined criteria: adult level 1 (tertiary) ( n = 8) and level 2a (supra-district) ( n = 7) services; and children’s services ( n = 2). Main measures: Annual service costs were collated using a standard costing template, and divided according to principal cost type (direct/indirect/overheads) and behaviour (variable/non-variable). For comparison between the level 1 and 2a services, costs and service characteristics were calculated per occupied bed. Results: The percentage breakdown of costs was consistent across all three service types, with direct costs making up 83%, indirect 10%, and overheads 7% of total costs. The median variable component ranged from 75 to 76%. Staff pay made up 66% and accounted for 95% of the variance of the total costs in adult services. Level 1 services had higher total staffing costs, mainly reflecting higher therapy staff numbers ( z = –2.0, P = 0.05). The median total costs/bed-day were: level 1 £530 (interquartile range (IQR) 435–574) (equivalent to US$860 or €650) and level 2a £402 (US$650 or €459) (IQR 326–451) ( z = –2.5, P = 0.009). Children’s services cost almost twice that (£1017–1177). Conclusions: Expected variations in cost are largely due to differences in staff costs. Total staff costs projected by 150% provided a reasonable estimate of total unit costs.