Cost effectiveness of community-based rehabilitation (CBR) programme for disabled children in Malaysia: a comparison between centre-based and home-based care

Abstract

Community-Based Rehabilitation (CBR) programme is being implemented in more than 90 countries worldwide. Concerns have been voiced out on the effectiveness of CBR. Thus, this study was aimed to identify cost effectiveness of CBR programme for disabled children by comparing centre-based with home-based care. The first part of the study assessed on the satisfaction level of parents, caregivers and CBR workers on CBR programme, the improvement in health outcome (Barthel Index and Devel opmental Disability – Children Global Assessment Scale) and quality of life (Eu roQol-5Dimensions-3Level: 2 proxy) of disabled children. The second part of the study iden-tified the parents’, caregivers’ and CBR workers’ views on CBR pro gramme. A total of 297 disabled children with their parents and caregivers and 204 CBR workers from 29 selected CBR centres in the East Coast region of Peninsular Malaysia participated in this study. The third part of the study was conducted to com pare the cost and out-comes of centre-based with home-based care. Costs were esti mated from a societal perspective. Incremental Cost Effectiveness Ratio (ICER) was determined by changes in cost per unit Quality-Adjusted Life Year (QALY). Gain in QALY for centre-based was higher than home-based care (60.52 vs. 38.78, p ≤ 0.001) and cost per QALY gained for centre-based was higher than home-based (RM 397.11 vs. RM 301.20, p < 0.001). The centre-based programme was more cost-effective than home-based care, with ICER of RM 568.18 per QALY gained which is less than one gross domestic product per capita (GDP) for 2014. In conclusion, the centre-based programme was proven to be highly cost-effective as compared to home-based care programme