Costs of care for individuals with PIMD/polyhandicap in France in relation to the adequacy of care structure based on age and severity - 06/07/26

Doi : 10.1016/j.jeph.2026.203779

Ilyes Hamouda ^1,^2,^⁎ , Marie-Christine Rousseau ³ , Anne Terraz Ayela ³ , Any Beltran ^1,² , Sibylle Del Duca ^1,² , Houria El Ouazzani ^1,² , Souad Loukkal ^1,² , Karine Baumstarck ^1,² , Sandrine Loubiere ^1,²

EVAL-PLH Group ^{^§}
The EVAL-PLH group: Thierry Billette de Villemeur, Marie-Christine Rousseau, Sherezad Khaldi-Cherif, Kim Maincent, Agnès Felce, Karine Baumstarck, Pascal Auquier, Lionel Dany, Any Beltran, Ilyes Hamouda, Marie-Anastasie Aim, Narjess Boutalbi, Isabelle Kemlin, Julie Roger, Patrick Julien, Ponha Heng, Daniel Willocq, Maria Valkov, Stéphane Pietra, Stéphane Lenormand & Katia Lind

¹ Department of Clinical Research and Innovation, Support Unit for clinical research and economic evaluation, Assistance Publique – Hôpitaux de Marseille, AP-HM, Marseille, France;

² Research Unit EA 3279, CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, 27, Boulevard Jean-Moulin, Marseille, France;

³ Fédération Hôpitaux de Polyhandicap et Multihandicap, Hôpital San Salvadour, University Hospital of Paris, 4312 Rte de l’Almanarre, Hyères, APHP, France

^⁎ Corresponding author: Ilyes HAMOUDA, Aix-Marseille Université, Faculté des Sciences Médicale et Paramédicales, UR 3279 – Centre d’Etudes et de Recherche sur les Services de Santé et qualité de vie, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France Aix-Marseille Université Faculté des Sciences Médicale et Paramédicales UR 3279 – Centre d’Etudes et de Recherche sur les Services de Santé et qualité de vie, 27 Bd Jean Moulin, 13385 Marseille Cedex 5 France

Sous presse. Manuscrit accepté. Disponible en ligne depuis le Monday 06 July 2026

Highlights

•	The first study on the costs of care for people with PIMD/polyhandicap in France.
•	Medical resource use by a person with PIMD/polyhandicap, by type of care facility.
•	Inconsistencies in the referral or retention of patients both types of structure.

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ABSTRACT

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 €70192 ± 34301 vs. €157736 ± 24200; 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 (€81205 ± 31822 vs. €63104 ± 33905; 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.

Le texte complet de cet article est disponible en PDF.

Keywords : Health care, costs, PIMD/polyhandicap, France