Economic effects of the Municipality Occupational Therapy Services in Norway

Abstract

For every society, it is important to know the effective and efficient health care interventions that ensure a more efficient use of scarce health care resources. Care of dementia is extremely resource demanding and has a great impact on both the formal care systems and the condition for informal carers. Occupational therapy (OT) is likely to be useful in dementia care. It is also recommended by the occupational therapists that a stair lift is the right solution for old or many younger individuals with disabilities who want to stay independently in their own home. From the policy perspective, nonetheless, the questions of cost-effectiveness of such interventions are vital. This study aims to assess whether municipality occupational therapy is a costeffective service option for home-based persons with reduced function in Norway. Two types of subjects have been considered for the analyses: older patients with dementia and people who use and are supposed to need a stair lift in their apartments. To get the information regarding the OT intervention and its effects on the differences in health care quantities used by the dementia patients between case (OT users) and control (usual care users) groups, a rigorous literature review has been conducted. Based on our literature search, we have considered the study from the Netherlands (the study based on randomized control trials). We estimate economic benefits/costs from the point of societal perspective. Employing the number of health care units used per patient during three months follow-up period that estimated in the study from the Netherlands, and using Norwegian wages/prices for different health care units, we present a hybrid estimate of the economic effects of OT intervention for the dementia patient in Norway. All costs have been calculated from the employee costs multiplied by a percentage for employer premiums as social taxes, holidays, and employee other benefits. Overall, our estimates indicate that community OT intervention for people with dementia is cost-effective in Norway. Our estimates demonstrate that with a probability of 95 %, on average it saves NOK 42,427 (95 % CI: 33,678 and 51,176) over three months per successfully treated dementia patient with OT. The main cost savings are from reduced informal care for the intervention group (NOK 48,387.42), around 90 % of total costs are owing to informal care costs. Based on the information collected through a small scale interviews with the user of a stair lift and potential-user (persons that have been concluded to need a stair lift, and are waiting for the installation), a quantitative cost-effectiveness analysis has been conducted. From the self-assessed descriptions provided by the informants, it is rather apparent that having a stair lift is effective in improving the users’ daily livings, quality of life, and reducing informal cares time. Based on some restrictive assumptions, it seems that the intervention is cost-effective as well. From a societal view point, particularly in terms of informal care costs, our tentative conclusion is that community OT appears to be a cost-effective intervention strategy for the patients with dementia in Norway. Similar conclusion can also be drawn for the stair lift intervention. Yet, to be more confident on our conclusions, we recommend further comprehensive research on these issues.