ABSTRACT
This chapter examines evidence that neuropsychological rehabilitation is cost-effective and represents value for money. Until recently, little attention was given to this aspect of rehabilitation (McGregor and Pentland, 1997; McKenna et al., 1992) but it is now recognised as increasingly relevant for neuropsychologists and other clinicians (Prigatano and Morrone-Strupinsky, 2010; Prigatano and Pliskin, 2003; Watson, 2000). In the 1970s, with interest from economists, health care first came to be viewed as a commodity that could be exchanged at a cost for health benefits. Following Grossman (1972), consumption of health care brings benefits that are both direct, in the form of freedom from illness, suffering and distress, and indirect as a kind of investment that yields other benefits, such as income generation and occupational opportunities. Many studies now measure improvements either in the health condition targeted by the intervention or the wider societal benefits linked to better health. Technological innovations promise longer healthier lives but come at increasing cost to financially stretched budgets, with inevitable tensions between what is possible and what is desirable or realistic for society. Consequently accurate cost data are an essential requirement when evaluating novel treatments and new ways of working. As Hall and Cope (1995, p.11) stated ‘cost-effectiveness issues are inherently difficult as individual and societal values influence the determination of worthiness and inevitably conflict and fluctuate. Information on relative value should be attainable, however’. After an initial definition of key terms, we review current evidence on cost outcomes of both restorative and compensatory approaches in neuropsychological rehabilitation and the theoretical and practical difficulties of undertaking economic analysis in this field of health care.
