Scenario | Robot-assisted training (n=257) | EULT (n=259) | Usual care (n=254) | ICER | Probability of each therapy being cost-effective at the £20 000 WTP threshold | ||
Robot-assisted training | EULT | Usual care | |||||
Base-case analysis | |||||||
Cost—£, unadjusted, mean (CI)* | 5387 (4777 to 5996) | 4451 (3548 to 5354) | 5387 (4777 to 5996) | – | – | – | – |
QALY—unadjusted, mean (CI)* | 0.21 (0.195 to 0.229) | 0.23 (0.213 to 0.244) | 0.21 (0.194 to 0.230) | – | – | – | – |
ICER (£ per QALY)—adjusted EULT vs usual care† | – | – | – | 74 100 | 0.00 | 0.19 | 0.81 |
Subgroup analysis (less than 3 months—time since stroke) | |||||||
Cost—£, unadjusted, mean (CI) | 5485 (3938 to 7032) | 3863 (2527 to 5199) | 3328 (1443 to 5213) | – | – | – | – |
QALY—unadjusted, mean (CI)* | 0.22 (0.19 to 0.25) | 0.24 (0.20 to 0.28) | 0.21 (0.17 to 0.25) | – | – | – | – |
ICER (£ per QALY)—adjusted EULT vs usual care† | – | – | – | 31 400 | 0.00 | 0.41 | 0.59 |
Subgroup analysis (3 to 12 months—time since stroke) | |||||||
Cost—£, unadjusted, mean (CI)* | 5790 (4793 to 6786) | 5084 (3393 to 6774) | 4943 (3228 to 6658) | – | – | – | – |
QALY—unadjusted, mean (CI) | 0.20 (0.18 to 0.23) | 0.23 (0.20 to 0.25) | 0.21 (0.19 to 0.24) | – | – | – | – |
ICER (£ per QALY)—adjusted EULT vs usual care† | – | – | – | 79 400 | 0.04 | 0.37 | 0.59 |
Subgroup analysis (more than 12 months) | |||||||
Cost—£, unadjusted, mean (CI)* | 4822 (4036 to 5728) | 3961 (2783 to 5138) | 2823 (1299 to 4348) | – | – | – | – |
QALY—unadjusted, mean (CI)* | 0.22 (0.18 to 0.25) | 0.23 (0.20 to 0.25) | 0.21 (0.18 to 0.24) | – | – | – | – |
ICER (£ per QALY)—adjusted EULT vs usual care§ | – | – | – | 126 143 | 0.01 | 0.15 | 0.84 |
Per-protocol analysis | |||||||
Cost—£, unadjusted, mean (CI)* | 5595 (4929 to 6261) | 4551 (3596 to 5501) | 3785 (2801 to 4770) | – | – | – | – |
QALY—unadjusted, mean (CI)* | 0.22 (0.20 to 0.24) | 0.23 (0.21 to 0.25) | 0.21 (0.19 to 0.23) | – | – | – | – |
ICER (£ per QALY)—adjusted EULT vs usual care† | – | – | – | 68 000 | 0.00 | 0.17 | 0.83 |
Extrapolation to 12 months | |||||||
Cost—£, unadjusted, mean (CI)* | 7538 (6350 to 8725) | 6892 (5149 to 8635) | 6916 (5003 to 8830) | – | – | – | – |
QALY—unadjusted, mean (CI)* | 0.44 (0.40 to 0.48) | 0.48 (0.44 to 0.51) | 0.45 (0.41 to 0.48) | – | – | – | – |
ICER (£ per QALY)—adjusted EULT vs usual care† | – | – | – | 6095 | 0.10 | 0.55 | 0.35 |
*98.33% CI used throughout the analyses for the three-arm comparison.
†Data adjusted for baseline costs, baseline utility score, study centre, randomised group and time since stroke.
EULT, enhanced upper limb therapy; ICER, incremental cost–effectiveness ratio; QALY, quality adjusted life year; WTP, willingness to pay.