Journal Article

Economic evaluation of robot-assisted training versus an enhanced upper limb therapy programme or usual care for patients with moderate or severe upper limb functional limitation due to stroke: results from the RATULS randomised controlled trial

Ford, Gary, Krebs, H I, Hughes, Niall, Price, Christopher, Cohen, David, Homer, Tara Marie, Wilson, Nina, Wilkes, Scott, Bosomworth, Helen, Francis, Richard, Fernandez-Garcia, Cristina, Rodgers, Helen, Vale, Luke, Hogg, Steven, Andole, Sreeman, Aird, Lydia, Turner, Duncan, Van Wijck, Frederike, Ternent, Laura, Finch, Tracy, Dawson, Jesse, Shaw, Lisa

2021

Overview

ObjectiveTo determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care.DesignEconomic evaluation within a randomised controlled trial.SettingFour National Health Service (NHS) centres in the UK: Queen’s Hospital, Barking, Havering and Redbridge University Hospitals NHS Trust; Northwick Park Hospital, London Northwest Healthcare NHS Trust; Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde; and North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust.Participants770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke.InterventionsParticipants randomised to one of three programmes provided over a 12-week period: robot-assisted training plus usual care; the EULT programme plus usual care or usual care.Main economic outcome measuresMean healthcare resource use; costs to the NHS and personal social services in 2018 pounds; utility scores based on EQ-5D-5L responses and quality-adjusted life years (QALYs). Cost-effectiveness reported as incremental cost per QALY and cost-effectiveness acceptability curves.ResultsAt 6 months, on average usual care was the least costly option (£3785) followed by EULT (£4451) with robot-assisted training being the most costly (£5387). The mean difference in total costs between the usual care and robot-assisted training groups (£1601) was statistically significant (p<0.001). Mean QALYs were highest for the EULT group (0.23) but no evidence of a difference (p=0.995) was observed between the robot-assisted training (0.21) and usual care groups (0.21). The incremental cost per QALY at 6 months for participants randomised to EULT compared with usual care was £74 100. Cost-effectiveness acceptability curves showed that robot-assisted training was unlikely to be cost-effective and that EULT had a 19% chance of being cost-effective at the £20 000 willingness to pay (WTP) threshold. Usual care was most likely to be cost-effective at all the WTP values considered in the analysis.ConclusionsThe cost-effectiveness analysis suggested that neither robot-assisted training nor EULT, as delivered in this trial, were likely to be cost-effective at any of the cost per QALY thresholds considered.Trial registration numberISRCTN69371850.

• Publisher: British Medical Journal Publishing Group,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Acceptability / Capital costs / Community health care / Cost analysis / Costs / Economics / Effectiveness / Havering / Health care / Health care expenditures / Health Economics / Health services / Hospitals / Intervention / Limbs / Medical treatment / Patients / Primary care / Quality adjusted life years / Quality of life / Questionnaires / Registration / Rehabilitation / rehabilitation medicine / Robotics / Robots / Social services / Stroke / stroke medicine / Success / Therapy / Thresholds / Training / Trust / Trust hospitals / Willingness to pay