RT Journal Article
SR Electronic
T1 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
JF BMJ Open
JO BMJ Open
FD British Medical Journal Publishing Group
SP e042081
DO 10.1136/bmjopen-2020-042081
VO 11
IS 5
A1 Fernandez-Garcia, Cristina
A1 Ternent, Laura
A1 Homer, Tara Marie
A1 Rodgers, Helen
A1 Bosomworth, Helen
A1 Shaw, Lisa
A1 Aird, Lydia
A1 Andole, Sreeman
A1 Cohen, David
A1 Dawson, Jesse
A1 Finch, Tracy
A1 Ford, Gary
A1 Francis, Richard
A1 Hogg, Steven
A1 Hughes, Niall
A1 Krebs, H I
A1 Price, Christopher
A1 Turner, Duncan
A1 Van Wijck, Frederike
A1 Wilkes, Scott
A1 Wilson, Nina
A1 Vale, Luke
YR 2021
UL http://bmjopen.bmj.com/content/11/5/e042081.abstract
AB Objective To determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care.Design Economic evaluation within a randomised controlled trial.Setting Four 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.Participants 770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke.Interventions Participants 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 measures Mean 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.Results At 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.Conclusions The 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 number ISRCTN69371850.Data are available upon reasonable request. De-identified participant data will be made available to scientific researchers upon approval of their study protocol and analysis plan, by a committee of the RATULS team. Proposals should be directed to the corresponding author. A data sharing agreement will need to be signed by data requestors.