What is a cost effective solution?

What is a cost effective solution?  

Cost effectiveness is something we need to consider when recommending equipment for a person, but what exactly is cost effective solution? 

cost effective solution is not necessarily a low cost solution, or the cheapest solution of a particular type of equipment.   When considering whether an item is a cost effective solution we do need to consider the initial purchase price, but we also need to consider a range of other factors, for example the features that a product offers (and how these relate to the identified goals), the materials the product is made from and the ongoing cost of maintaining and repairing a product.  For this blog we are going to look at wheelchairs in particular, however these ideas can be applied to other pieces of equipment. 

As part of establishing what is a cost effective option we need to consider the person using the chair and where the chair will be used.  We need to consider whether the person’s needs are stable and the chair will be used in its original configuration for quite some time, or whether we are looking at a teenager who is going to grow out of their chair within a reasonably short period of time or perhaps a person with a progressive condition who may need their chair adapted as their needs change.  We also need to consider where a piece of equipment is going to be used – is it going to be used mostly indoors with occasional outdoor use, or will this person be using their chair extensively outdoors, and is this outdoor terrain flat or are there hills?  These factors can help us determine how durable a solution needs to be and whether we need a solution is adaptable to changing needs over timehelping maximise the length of time a chair can be used by the person. 

When looking at chair options we also need to be mindful of how chairs are promoted and their reported capability, in particular modifications to increase functionality of the chair.  We need to be wary that because a modification can be done, it doesn’t necessarily mean that it should be done, pushing a product past its intended use typically results in issues at some stage, either poor functioning in the short term or repair and maintenance issues in the long term, ultimately defying the intent of providing a cost effective solution.  An important aspect to consider on all equipment is what the safety parameters are on a product, for example lock out parameters on a power wheelchair are in place to keep a person safe while using their chair, over riding these to increase the functionality of a chair is never a good idea.
Looking at manual wheelchairs – the materials used in these is an important consideration.  The two common materials we see are titanium and aluminium both of these are strong lightweight materials, however they have different life spans – with titanium being more durable and the higher cost option.  What does this mean for cost effectiveness?  For wheelchair users that use their chairs full time and whose needs are stable, a titanium frame is typically a cost effective option as it a robust solution that will last a number of years, with the frame often having a lifetime warranty and the componentry being the part of the chair that requires attention over time.  However for a person who’s needs are likely to change over time, due to growth or a change in functional ability, they may not use the manual chair long enough for a lifetime warranty to be relevant, hence an aluminium frame is likely to be the more cost effective option, with the person changing chairs before the aluminium frame is at risk of failure.  Where does carbon fibre fit into the cost-effective equation? Carbon fibre tends to be a higher cost option, but it can also be the lightest option of the three, and may prove to be the cost effective option for other reasons, for example if provision of a very lightweight chair means vehicle modifications are not required.  The big consideration with carbon fibre is that a wheelchair user needs to treat it with care, so is only a cost effective option if they are given to the right person.

Establishing cost effectiveness for power wheelchairs can be a little trickier, as we need to ensure we are comparing apples with apples.  Power wheelchairs range in their complexity, purchase cost and ongoing repair and maintenance costs.  A good place to start is to establish what features a person needs in their power wheelchair and then establishing which models fit these specifications, considering aspects such as power seat functions required, power wheelchair performance and what a person’s long term needs might be.   All power wheelchairs have their benefits and their challenges, and we need to ensure that we match these benefits and challenges to the wheelchair user.  Often this process results in a couple of chair options being identified, however sometimes we are faced with the dilemma of do we upgrade to ‘future proof’ the chair (at an additional cost) or do we go with the chair that meets the needs of the person now? 
Often, we have a gut instinct on whether we should consider upgrading a chair, however finding the words to justify the increased cost for an upgrade can be a challenge.  This is where consulting with other team members can be helpful, for example consulting with the wider multidisciplinary team if a person has a progressive condition to establish the rate a person’s functional abilities are changing, and hence what wheelchair features may be required in the medium term, then establishing whether it is more cost effective to provide these features now or whether it is something that is cost effective to provide later, such as retrofitting of power seat functions.  If we are considering power wheelchair performance, discussing what demands will be placed on the chair with a technician or dealer can be helpful, this can help align the more technical aspects of a chair with the needs of a user, for example whether 500W motors are going to be a better option than 300W motors for the person who needs to travel up a hill to work each day.
One last aspect of cost effectiveness doesn’t relate to the chair at all, which is the effect on the persons environment.  The subtle differences between chair specifications can cause significant ripple effects through other parts of a person’s life, for example a 1” increase in seat to floor height or in overall width can make the difference between a person accessing their modified vehicle, or not.  The decision between a power wheelchair and power assist can be influenced by a person’s home environment and what changes may need to be made to accommodate a larger power wheelchair base.  Or provision of an additional power seat function can result in maintaining, or even decreasing, the level of a support a person needs to function.
Establishing whether a solution is cost effective can be tricky with many different aspects to cover, please feel free to reach out to our team if you are wanting to discuss a solution further on 

Rachel Maher
Clinical Education Specialist

Rachel Maher graduated from the University of Otago in 2003 with a Bachelor of Physiotherapy, and a Post Graduate Diploma in Physiotherapy (Neurorehabilitation) in 2010.
Rachel gained experience in inpatient rehabilitation and community Physiotherapy, before moving into a Child Development Service.Rachel moved into a Wheelchair and Seating Outreach Advisor role at Enable New Zealand in 2014, complementing her clinical knowledge with experience in NZ Ministry of Health funding processes.
Rachel joined Permobil in June 2020, and is passionate about education and working collaboratively to achieve the best result for our end users.

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