Fernandez-Garcia, Cristina; Ternent, Laura; Homer, Tara Marie; Rodgers, Helen; Bosomworth, Helen; Shaw, Lisa; Aird, Lydia; Andole, Sreeman; Cohen, David; Dawson, Jesse; +12 more... Finch, Tracy; Ford, Gary; Francis, Richard; Hogg, Steven; Hughes, Niall; Krebs, HI; Price, Christopher; Turner, Duncan; Van Wijck, Frederike; Wilkes, Scott; Wilson, Nina; Vale, Luke; (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 (5). e042081. ISSN 2044-6055 DOI: https://doi.org/10.1136/bmjopen-2020-042081
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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. TRIAL REGISTRATION NUMBER: ISRCTN69371850.
Item Type | Article |
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Faculty and Department | Faculty of Public Health and Policy > Dept of Health Services Research and Policy |
PubMed ID | 34035087 |
Elements ID | 212110 |
Official URL | http://dx.doi.org/10.1136/bmjopen-2020-042081 |
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Filename: Fernandez-garcia-etal-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.pdf
Licence: Creative Commons: Attribution 4.0
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