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This chapter discusses health-economic perspectives in reablement and describes evaluation methods such as cost analysis, cost-effectiveness, and cost-utility analysis. The aim is to provide a summary of existing evidence, and to discuss health economic perspectives of reablement from a clinical and future research perspective. Eight studies comparing reablement to conventional home care were included; four cost-analyses and four cost-effectiveness analyses; time horizons for follow-up varied from 6 weeks to a lifetime perspective.
The results indicated that reablement was the more cost-effective intervention in seven studies; in five studies reablement resulted in both larger effects and/or lower costs; in two studies reablement resulted in larger effects and larger costs within established cost-effectiveness thresholds. A summary of the existing evidence indicates that reablement is promising regarding cost-effectiveness compared to usual home care services, but the evidence base is limited; additional studies designed to capture health-economic perspectives over the long term are urgently needed.
This chapter describes client-level outcomes used for evaluating reablement. The authors have examined outcomes and instruments used in empirical, clinical trials regarding reablement, and provide an overview of this. A literature review and a comparative analysis have been conducted to examine which client-level outcomes and instruments have been used in different countries across the world. An analysis including 18 studies deriving from nine countries has been conducted. In all, 12 categories of client-level outcomes were identified. Functional independence in ADL, physical functioning and health-related quality of life were the most frequently used outcomes. In all, a total of 40 instruments were used, of which the Barthel ADL Index, EQ-5D and TUG were the ones most frequently used.
