OBJECTIVE: To report if there is a difference in costs from a societal perspective between adults receiving rehabilitation in an inpatient rehabilitation versus an alternate setting. If there are cost differences, to report whether opting for the least expensive program setting adversely affects patient outcomes. DATA SOURCES: Electronic databases. Earliest possible date until May 2011. All languages. STUDY SELECTION: Multiple reviewers identified randomized controlled trials with a full economic evaluation that compared adult inpatient rehabilitation to an alternate. There were 29 included trials with 6,746 participants. DATA EXTRACTION: Multiple observers extracted data independently. Trial appraisal included a risk of bias assessment and a checklist to report the strength of the economic evaluation. DATA SYNTHESIS: Results were synthesised using standardized mean differences (SMD) and meta-analyses for the primary outcome of cost. The GRADE assessment was applied to assess for risk of bias across studies for meta-analyses. There was high quality evidence that cost was significantly reduced for rehabilitation in the home versus inpatient rehabilitation in a meta-analysis of 732 patients post stroke (pooled SMD (delta) -0.28 95% CI -0.47 to -0.09), without compromise to patient outcomes. Results of individual trials in other patient groups (orthopaedic, rheumatoid arthritis, and geriatric) receiving rehabilitation in the home or community were generally consistent with the meta-analysis. There was moderate quality evidence that cost was significantly reduced for inpatient rehabilitation (stroke unit) versus general acute care in a meta-analysis of 463 patients post stroke (delta 0.31 95% CI 0.15 to 0.48), with improvement to patient outcomes. These results were not replicated for two individual trials with a geriatric and a mixed cohort where costs did not differ between general acute care and inpatient rehabilitation. Three of the four individual trials, inclusive of a stroke or orthopaedic population, reported less cost for an intensive inpatient rehabilitation program, compared to usual inpatient rehabilitation. Sensitivity analysis included a health service perspective and varied inflation rates with no change to the significant findings of the meta-analyses. CONCLUSIONS: Based on this systematic review and meta-analyses a single rehabilitation service may not provide health economic benefits for all patient groups and situations. For some patients inpatient rehabilitation may be the most cost effective method of providing rehabilitation, yet for other patients rehabilitation in the home or community may be the most cost effective model of care. To achieve cost effective outcomes the ideal combination of rehabilitation services and patient inclusion criteria, and further data for non-stroke populations warrant further research.

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