Predicting effect and evaluating cost-effectiveness of a family intervention after acquired brain or spinal cord injury: a randomized controlled trial
DOI:
https://doi.org/10.2340/jrm.v58.44691Keywords:
economic evaluation, health economic analysis, neurorehabilitation, stroke, family interventionAbstract
Objective: To predict treatment response of a family intervention and investigate its cost-effectiveness from a healthcare payer perspective.
Design: Explorative predictor analyses and trial-based economic evaluation.
Subjects/Patients: Participants (n=157) were enrolled 4 months to 2 years after discharge from a specialized neurorehabilitation unit.
Methods: Injury type, time since injury, delivery format, and relationship (individual with injury vs family member) were explored as predictors of effect using linear mixed-effect regression. Cost-effectiveness was analysed from a healthcare payer perspective, with incremental cost based on delivery. Incremental health effect was reported for measures on mental health and anxiety and depression symptoms.
Results: The 4 predictors had negligible to small effects on the treatment response. Incremental cost for the family intervention was estimated at €798.16 (CI: €700.9; €895.5). Incremental health effect was estimated at 5.64 (CI: 2.71, 8.56) points on the Mental Component Summary at 2 months’ follow-up. At a willingness-to-pay threshold of €300, the probability of the intervention being cost-effective was 99.8% for the Mental Component Summary.
Conclusion: The predictors showed no or little effect on the treatment response, and the cost-effectiveness analysis showed the probabilities of the intervention being cost-effective from a health payer perspective.
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References
Norup A. Family matters in neurorehabilitation: why, when, who, and how? Revista Iberoamericana de Neuropsicología 2018; 1: 17–34.
Rodgers ML, Strode AD, Norell DM, Short RA, Dyck DG, Becker B. Adapting multiple-family group treatment for brain and spinal cord injury intervention development and preliminary outcomes. Am J Phys Med Rehabil 2007; 86: 482–492. DOI: https://doi.org/10.1097/PHM.0b013e31805c00a1
Goldman L, Siddiqui EM, Khan A, Jahan S, Rehman MU, Mehan S, et al. Understanding acquired brain injury: a review. Biomedicines 2022; 10: 2167. DOI: https://doi.org/10.3390/biomedicines10092167
World Health Organization. Fact sheet. Spinal cord injury. Geneva: World Health Organization; 2024 [cited 2024 Nov 18]. Available from: https://www.who.int/news-room/fact-sheets/detail/spinal-cord-injury
Baker A, Barker S, Sampson A, Martin C. Caregiver outcomes and interventions: a systematic scoping review of the traumatic brain injury and spinal cord injury literature. Clin Rehabil 2017; 31: 45–60. DOI: https://doi.org/10.1177/0269215516639357
Wilson CS, DeDios-Stern S, Bocage C, Gray AA, Crudup BM, Russell HF. A systematic review of how spinal cord injury impacts families. Rehabil Psychol 2022; 67: 273–303. DOI: https://doi.org/10.1037/rep0000431
Ponsford J, Olver J, Ponsford M, Nelms R. Long-term adjustment of families following traumatic brain injury where comprehensive rehabilitation has been provided. Brain Inj 2003; 17: 453–468. DOI: https://doi.org/10.1080/0269905031000070143
Page TA, Gordon S, Balchin R, Tomlinson M. Caregivers’ perspectives of the challenges faced with survivors of traumatic brain injury: a scoping review. NeuroRehabilitation 2021; 49: 349–362. DOI: https://doi.org/10.3233/NRE-210099
Soendergaard PL, Arango-Lasprilla JC, Wolffbrandt MM, Dornonville de la Cour FL, Biering-Sørensen F, Norup A. Investigating the effectiveness of a family intervention after acquired brain or spinal cord injury: a randomized controlled trial. J Clin Med 2023; 12: 3214. DOI: https://doi.org/10.3390/jcm12093214
Grey AM, Clarke PM, Wolstenholme JL, Wordsworth S. Applied methods of cost-effectiveness analysis in health care. Oxford: Oxford University Press; 2011.
Rytter HM, Hjorthøj C, Graff HJ, Eplov LF, Nordentoft M, Benros ME, et al. Traumatic brain injury and long-term associations with work, divorce and academic achievement. Prev Med (Baltim) 2024; 185. DOI: https://doi.org/10.1016/j.ypmed.2024.108062
Soendergaard PL, Norup A, Kruse M, Biering-Sørensen F. Socioeconomic consequences of traumatic and non-traumatic spinal cord injuries: a Danish nationwide register-based study. Spinal Cord 2022; 60: 647–654. DOI: https://doi.org/10.1038/s41393-021-00724-3
Norup A, Kruse M, Soendergaard PL, Rasmussen KW, Biering-Sørensen F. Socioeconomic consequences of traumatic brain injury: a Danish nationwide register-based study. J Neurotrauma 2020; 37: 2694–2702. DOI: https://doi.org/10.1089/neu.2020.7064
Stolwyk RJ, Gooden JR, Kim J, Cadilhac DA. What is known about the cost-effectiveness of neuropsychological interventions for individuals with acquired brain injury? A scoping review. Neuropsychol Rehabil 2021; 31: 316–344. DOI: https://doi.org/10.1080/09602011.2019.1692672
Mousavi M, Daroudi R, Shirazikhah M, Alizadeh Zarei M, Hendi H, Joghataei F, et al. Economic evaluation of rehabilitation of spinal cord injury patients in Iran in 2019. J Rehabil 2022; 23: 412–433. DOI: https://doi.org/10.1080/14737167.2023.2251689
Mancuso M, Valentini I, Basile M, Bowen A, Fordell H, Laurita R, et al. Cost-effectiveness of neuropsychological rehabilitation for acquired brain injuries: update of Stolwyk et al.’s (2019) review. J Neuropsychol 2024; 19: 115–139. DOI: https://doi.org/10.1111/jnp.12387
Stevens LF, Lehan T, Durán MAS, Plaza SLO, Arango-Lasprilla JC. Pilot study of a newly developed intervention for families facing serious injury. Top Spinal Cord Inj Rehabil 2016; 22: 49–59. DOI: https://doi.org/10.1310/sci2201-49
Sittimart M, Rattanavipapong W, Mirelman AJ, Hung TM, Dabak S, Downey LE, et al. An overview of the perspectives used in health economic evaluations. Cost Eff Resour Alloc 2024; 22. DOI: https://doi.org/10.1186/s12962-024-00552-1
Husereau D, Drummond M, Augustovski F, de Bekker-Grob E, Briggs AH, Carswell C, et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. Eur J Health Econ 2022; 23: 1309–1317. DOI: https://doi.org/10.1136/bmj-2021-067975
Charles JM, Edwards RT, Bywater T, Hutchings J. Micro-costing in public health economics: steps towards a standardized framework, using the incredible years toddler parenting program as a worked example. Prevention Science 2013; 14: 377–389. DOI: https://doi.org/10.1007/s11121-012-0302-5
Danish Health Technology Council. Vejledning i omkostningsopgørelse [Guide to cost calculation]. Aalborg; 2021 [cited 2025 Aug 22]. Available from: https://behandlingsraadet.dk/media/2gqau11x/tb-vejledning-til-omkostningsopg%C3%B8relse-v-1-3.pdf
Ehlers LH, Vestergaard AS. Costing in health economic evaluation. theory and practice. 1st ed. Aalborg: Aalborg University Press; 2019.
Danish Ministry of Taxation. Kørselsfradraget og befordringsgodtgørelsen falder i 2020 [Travel deduction and the mileage allowance in 2020]. [cited 2024 Nov 13]. Available from: https://sktst.dk/nyheder-og-pressemeddelelser/koerselsfradraget-og-befordringsgodtgoerelsen-falder-i-2020
Ware JE, Sherbourne CD. The MOS 36-Item Short-Form Health Survey (SF-36) 1. Conceptual framework and item selection. 1992; 30. Available from: https://about.jstor.org/terms DOI: https://doi.org/10.1097/00005650-199206000-00002
Spitzer RL, Kroenke K, Williams JBW, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med (1960) 2006; 166: 1092–1097. DOI: https://doi.org/10.1001/archinte.166.10.1092
Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606–613. DOI: https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Kjeldgaard A, Soendergaard PL, Wolffbrandt MM, Norup A. Predictors of caregiver burden in caregivers of individuals with traumatic or non-traumatic brain injury: a scoping review. NeuroRehabilitation 2023; 52: 9–28. DOI: https://doi.org/10.3233/NRE-220134
Cohen J. A power primer. Psychol Bull 1992; 112: 155–159. DOI: https://doi.org/10.1037/0033-2909.112.1.155
Lorah J. Effect size measures for multilevel models: definition, interpretation, and TIMSS example. Large Scale Assess Educ 2018; 6: 1–11. DOI: https://doi.org/10.1186/s40536-018-0061-2
Quality Metric. User’s manual for the sf-36v2 health survey. Johnston, R: Quality Metric; 2009.
Kroenke K, Spitzer RL, Williams JBW, Löwe B. The Patient Health Questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 2010; 32: 345–359. DOI: https://doi.org/10.1016/j.genhosppsych.2010.03.006
Bates D, Maechler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. J Stat Softw 2015; 67: 1–48. DOI: doi:10.18637/jss.v067.i01 DOI: https://doi.org/10.18637/jss.v067.i01
Lenth R. emmeans: estimated marginal means, aka least-squares means. R package version 1.11.1. 2025 [cited 2025 Jun 24]. Available from: https://CRAN.R-project.org/package=emmeans
Scholten EWM, Ketelaar M, Visser-Meily JMA, Roels EH, Kouwenhoven M, Post MWM. Prediction of psychological distress among persons with spinal cord injury or acquired brain injury and their significant others. Arch Phys Med Rehabil 2020; 101: 2093–2102. DOI: https://doi.org/10.1016/j.apmr.2020.05.023
Ymer L, McKay A, Wong D, Frencham K, Grima N, Tran J, et al. Cognitive behavioral therapy for sleep disturbance and fatigue following acquired brain injury: predictors of treatment response. J Head Trauma Rehab 2022; 37: E220–E230. DOI: https://doi.org/10.1097/HTR.0000000000000705
Ymer L, McKay A, Wong D, Frencham K, Grima N, Roper M, et al. Predictors of response to cognitive behavioral therapy for sleep disturbance and fatigue after acquired brain injury: a secondary analysis of a randomized controlled trial. Arch Phys Med Rehabil 2025; 106: 1531–1538. DOI: https://doi.org/10.1016/j.apmr.2025.03.040
Wolffbrandt MM, Soendergaard PL, Biering-Sørensen F, Sundekilde L, Kjeldgaard A, Schow T, et al. A manual-based family intervention for families living with acquired brain or spinal cord injury: a qualitative study of families’ experiences. Disabil Rehabil 2024; 46: 4503–4513. DOI: https://doi.org/10.1080/09638288.2023.2280063
Armstrong A, Oetinger K, Weimer K, Hönig K. Digital psychosocial interventions for individuals with spinal cord injury: a scoping review. Front Psychiatry 2024; 15: 1289138. DOI: https://doi.org/10.3389/fpsyt.2024.1289138
Conklin JP, Wallace T, McCauley KL, Breitenstein J, Gore RK. Level of evidence of telehealth rehabilitation and behavioral health services for traumatic brain injury: a scoping review. J Clin Psychol Med Settings 2024; 31: 379–402. DOI: https://doi.org/10.1007/s10880-023-09981-1
Wolffbrandt MM, Kruse M, Biering-Sørensen F, Schow T, Norup A. Educational achievements, labor market attachment and family establishment in children of parents or siblings with acquired brain or spinal cord injury: a nationwide register study. Arch Phys Med Rehabil 2025; 106: 1539–1547. DOI: https://doi.org/10.1016/j.apmr.2025.06.004
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Copyright (c) 2026 Karoline Yde Andersen, Frederik Have Dornonville de la Cour, Mia Moth Wolffbrandt, Fin Biering-Sørensen, Juan Carlos Arango-Lasprilla, Pernille Langer Soendergaard, Anne Norup

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