Priority 10 from the Occupational Therapy PSP

UNCERTAINTY: What is the cost-effectiveness of occupational therapy services? (JLA PSP Priority 10)
Overall ranking 10
JLA question ID 0100/10
Explanatory note

There is a lack of economic evaluations of occupational therapy service delivery. It is acknowledged that many will feel uncomfortable at the thought that 'cost' might be prioritised over other measures, such as the outcomes and experiences of the people who access occupational therapy services. In the context of limited public funding, and the expectation that statutory services spend tax-payers' money wisely, it is important that the profession can demonstrate that our services make a difference to people's lives and are cost-effective in doing so.

This question therefore aims to provide evidence about the extent to which different occupational therapy services and interventions offer value for money and are therefore worth investing in.


There is currently one systematic review (Green and Rod, 2017) that considers econonic evaluations in OT (which concludes a lack of robust evidence). Studies published after this study focus on specific areas. The area has not be comprehensively researched. This is an area of uncertainty.
Brandt, Å., et al. (2016). "Effectiveness of the "Cancer Home-Life Intervention" on everyday activities and quality of life in people with advanced cancer living at home: a randomised controlled trial and an economic evaluation." BMC Palliative Care 15: 10-10.
Clarke, C. E., et al. (2016). "Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson's disease: a large pragmatic randomised controlled trial (PD REHAB)." Health technology assessment (winchester, england) 20(63): 1-96.
Green, S. and R. Lambert (2017). "A systematic review of health economic evaluations in occupational therapy." British Journal of Occupational Therapy 80(1): 5-19.
Health, C. A. f. D. a. T. i. (2017). Occupational Therapy for Chronic Pain Management Using the Biopsychosocial Approach: A Review of the Clinical and Cost-Effectiveness and Guidelines.
Health, C. A. f. D. a. T. i. (2017). Occupational Therapy Interventions to Prevent Opioid Relapse: Clinical and Cost-Effectiveness and Guidelines.
Nagayama, H., et al. (2017). "Cost effectiveness of the occupation-based approach for subacute stroke patients: result of a randomized controlled trial." Topics In Stroke Rehabilitation 24(5): 337-344.
Nagayama, H., et al. (2016). "Effectiveness and Cost-Effectiveness of Occupation-Based Occupational Therapy Using the Aid for Decision Making in Occupation Choice (ADOC) for Older Residents: Pilot Cluster Randomized Controlled Trial." Plos One 11(3): e0150374-e0150374.
Nagayama, H., et al. (2016). "Cost-effectiveness of Occupational Therapy in Older People: Systematic Review of Randomized Controlled Trials." Occupational therapy international 23(2): 103-120.
Rahja, M., et al. (2018). "Economic evaluations of occupational therapy approaches for people with cognitive and/or functional decline: A systematic review." Health & Social Care in the Community 26(5): 635-653.
Sackley, C. M., et al. (2016). "An Occupational Therapy intervention for residents with stroke-related disabilities in UK Care Homes (OTCH): cluster randomised controlled trial with economic evaluation." Health technology assessment (winchester, england) 20(15): 1‐138.
Sampson, C., et al. (2014). "An introduction to economic evaluation in occupational therapy: cost-effectiveness of pre-discharge home visits after stroke (HOVIS)." British Journal of Occupational Therapy 77(7): 330-335.
Sturkenboom, I. H. W. M., et al. (2015). "Economic evaluation of occupational therapy in Parkinson's disease: A randomized controlled trial." Movement Disorders: Official Journal Of The Movement Disorder Society 30(8): 1059-1067.
Wales, K., et al. (2018). "A trial based economic evaluation of occupational therapy discharge planning for older adults: the HOME randomized trial." Clinical Rehabilitation 32(7): 919-929.

Health Research Classification System category Generic Health Relevance
Extra information provided by this PSP
Original uncertainty examples What are the quantitative financial impact/cost benefits of Occupational Therapy in mental health services?  ~ how effective OT can save the NHS money ~ How much money OTs in mental health services save the welfare state and the public purse. ~ Is occupational therapy delivered in primary care settings having a cost effective impact on reducing pressures on GP services.  ~ Cost savings to the public purse due to avoidance of hospital admissions and reductions in care packages attributed to Occupational Therapy Input.
Submitted by Occupational therapists, Carers, Students, Services Users, Other, Not Specified
PSP information
PSP unique ID 0100
PSP name Occupational Therapy
Total number of uncertainties identified by this PSP. 66  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 27 July 2020