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

Article


Fernandez-Garcia, C., Ternent, L., Homer, T. M., Rodgers, H., Bosomworth, H., Shaw, L., Aird, L., Andole, S., Cohen, D., Dawson, J., Finch, T., Ford, G., Francis, R., Hogg, S., Hughes, N., Krebs, H. I., Price, C., Turner, D., Van Wijck, F., Wilkes, S., Wilson, N. and Vale, L. 2021. 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. BMJ Open. 11 (Art. e042081). https://doi.org/10.1136/bmjopen-2020-042081
AuthorsFernandez-Garcia, C., Ternent, L., Homer, T. M., Rodgers, H., Bosomworth, H., Shaw, L., Aird, L., Andole, S., Cohen, D., Dawson, J., Finch, T., Ford, G., Francis, R., Hogg, S., Hughes, N., Krebs, H. I., Price, C., Turner, D., Van Wijck, F., Wilkes, S., Wilson, N. and Vale, L.
Abstract

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.

JournalBMJ Open
Journal citation11 (Art. e042081)
ISSN2044-6055
Year2021
PublisherBMJ Publishing Group
Publisher's version
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File Access Level
Anyone
Digital Object Identifier (DOI)https://doi.org/10.1136/bmjopen-2020-042081
Publication dates
Online25 May 2021
Publication process dates
Accepted28 Apr 2021
Deposited09 Jun 2021
FunderNational Institute for Health Research
Copyright holder© 2021 The Authors
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