The report is available in English with a French summary - KCE

226 Musculoskeletal & Neurological Rehabilitation KCE reports 57
Rommers 237 found an incidence of LEA in the Netherlands of 19/100.000. He also states
that about half of the patients are fitted with a prosthesis 66 . Based on other literature
data as described in chapter 2 and on data of the RIZIV/INAMI we estimate the
incidence in Belgium somewhat lower. (RIZIV/INAMI data: number of AK amputations
in 1995: 653, in 1998: 614; BK amputations in 1995: 448, in 1998: 489; number of
evaluation prostheses for BK provided in 2005 and 2006: 272 and 303; number of
evaluation prostheses for AK provided in 2005 and 2006: 213 and 282). Combining
these data, the number of LEA for Belgium is estimated at 1200/year. About 50% of the
patients are fitted with a prosthesis, almost as much for AK as for BK. This means 300
patients for subgroup 1 as well as for subgroup 2, when patients deserving a prosthesis
are taken into account for post-acute multidisciplinary rehabilitation, and patients
without prosthesis are assumed to follow monodisciplinary treatment.
The estimated incidence of SCI in Belgium based on literature (chapter 2) is between 1
and 3/100000. This seems to be confirmed by a newsletter of ISCoS (International
Spinal Cord Society) in December 2006. A European survey was performed, using a
questionnaire that was sent to experts in 21 European countries. The results showed a
mean incidence of SCI of 1,75/100000. So we estimate the number of new cases in
Belgium at 200/year, 100 paraplegics and 100 tetraplegics.
For MS the number of new cases in Belgium yearly is estimated at 400. The prevalence
in Belgium, which in this case is relevant as it concerns a progressive disorder, is
estimated at 10 000 (see chapter 2). Based on Belgian expert opinion, it is assumed that
+15% of the patients need continuous ambulatory rehabilitation, which means 1500
patients. Based on information of the FOD/SPF Volksgezondheid, Santé Publique
(Technical Cell), it was estimated that each year 10% of the MS patients need
hospitalization. These numvers are in line with the Flemish study published in 1998 by
Carton et al 240 .
Concerning stroke we estimate the number of new patients at 19 000/year (see chapter
2). According to the gold fist rule of Fortune and Wenn 238 , approximately 1/3 dies, 1/3
recovers and 1/3 presents with permanent disability. Of these patients only half is
younger than 75 years and even less are younger than 70 years. Part of these patients
goes directly to a nursing home and part of them can be treated in a geriatric ward. So
it is assumed that only about 15% of all stroke patients need post-acute rehabilitation
services, which brings us to 2860 patients yearly. This assumption was confirmed by the
real data of a Belgian expert centre (Stroke Unit discharge).
Especially for ambulatory rehabilitation, the percentages of patients needing
multidisciplinary rehabilitation are highly uncertain. To account for this uncertainty, a
beta distribution was applied to each of these percentages. This is the accepted
distribution for uncertain proportions. The upper and lower limits are essentially
arbitrary, as there are no data in literature or from centres that can provide a clue to
the ranges. The lower limit was therefore arbitrarily set at a rehabilitation need of 50%
of the point estimate and the upper limit at 130% of the point estimate. The point
estimate itself was defined as the mean of the beta distribution.
During the Monte Carlo simulation of the costs, revenues and expenditures for Belgium
as a whole, values are chosen at random from these distributions. This eventually leads
to total cost, revenue and expenditure estimates with a probabilistic distribution. 95%
confidence intervals were constructed around the point estimates based on the Monte
Carlo simulations. The analyses were performed in @risk version 4.5.5.
Because these five pathologies obviously do not cover the entire population in need of
multidisciplinary rehabilitation, it was assumed in the extrapolation that these five
pathologies cover about 75% of the total hospitalization costs and 60% of the total
ambulatory care costs for multidisciplinary rehabilitation. This is consistent with the
figures in chapter 2 for hospital rehabilitation and with the reported case-mix of two
non-university rehabilitation centres in Belgium. To account for the uncertainty
associated with this 60%, a beta distribution was applied to this variable, with an
arbitrary lower limit of 30% and an arbitrary upper limit of 78%. The mean of the
distribution was set at 60%.