Costs of care for individuals with PIMD/polyhandicap in France in relation to the adequacy of care structure based on age and severity

OBJECTIVE: The study aims to compare healthcare resource use per person with PIMD (profound intellectual and multiple disabilities)/polyhandicap receiving care either in specialised rehabilitation centres (SRCs) or residential facilities (RFs), and to study the effect of the adequacy for severity and age in relation with structure on the cost of care pathways. METHODS: Individuals included in the French national EVAL-PLH cohort with PIMD/polyhandicap and age at onset of cerebral lesion younger than 3 years old. Data were collected on the type of structure, patients' age and severity of health status, quality of life (PolyQoL scale), and health care use. Residential costs, outpatient visits, hospital admissions, intensive care unit stays and emergency attendances were measured. Mean annual costs and QoL scores were compared between SRCs and RFs in relation with the adequacy of care for age and severity. RESULTS: 618 patients (52% in RFs vs. 48% in SRCs) were included in the study (54% men, mean age 30 ± 17 years). The adequacy of the structure was not respected in 43% of cases. Compared to SRCs patients, RFs individuals spent 45% less on health care (mean costs €70,192 ± 34,301 vs. €157,736 ± 24,200; P < 0.001). In SRCs, overall care adequacy was associated with higher costs (P < 0.001). In RFs, significant higher costs were observed with inadequacy of care for severity (€81,205 ± 31,822 vs. €63,104 ± 33,905; P < 0.001). CONCLUSIONS: Incorporating health-economic criteria into patient-orientation decisions could improve the quality of care while reducing costs among patients with PIMD/polyhandicap.