HOME REHABILITATION, HEALTH-RELATED QUALITY OF LIFE, AND PROGRAMME COSTS IN SWEDISH MUNICIPAL CARE

Sammanfattning

Population ageing and demographic change are increasing the need for municipal services that support older adults’ independence, functioning, and quality of life in the community. However, rehabilitation outcomes are less often translated into health economic measures. In this thesis, I analyse before-and-after data collected within a FORTE research project in Jönköping Municipality, Luleå Municipality, and the City of Stockholm. The aim is to describe changes in health-related quality of life, estimate quality-adjusted life-years accrued over the observed rehabilitation episode, and summarise programme costs where cost data are available. The paired complete-case sample included 74 participants in Jönköping, 9 in Luleå, and 73 in Stockholm. Mean utility was higher at follow-up than at baseline in all three settings, with substantial variation between participants. Approximately one-third of participants achieved the main responder threshold for meaningful utility improvement. Higher baseline utility was negatively correlated with observed utility change and with the probability of being a responder. This pattern is consistent with ceiling effects on a bounded utility scale, although the study design is descriptive and cannot establish causality. In Jönköping, where individuallevel visit data were available, descriptive cost-outcome results suggested relatively low programme costs compared with more intensive municipal care. Because the study has no control group and follow-up is incomplete in two settings, the findings should not be interpreted as causal effects or incremental cost-effectiveness estimates. The main contribution is to show how research data from municipal home rehabilitation can be converted into utility, QALY, and cost-outcome measures that are useful for service planning and future economic evaluation.