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
Christopher Price,
Jesse Dawson,
Helen Rodgers,
Gary Ford,
Luke Vale,
Scott Wilkes,
David Cohen,
Laura Ternent,
Tracy Finch,
Lisa Shaw,
Richard Francis,
Nina Wilson,
Cristina Fernandez-Garcia,
Tara Marie Homer,
Helen Bosomworth,
Lydia Aird,
Sreeman Andole,
Steven Hogg,
Niall Hughes,
H I Krebs,
Duncan Turner,
Frederike Van Wijck
Affiliations
Christopher Price
Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
Jesse Dawson
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Helen Rodgers
2 Institute of Neuroscience (Stroke Research Group), Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Gary Ford
5Health Science Networks, Oxford University Hospitals, UK
Luke Vale
4 Newcastle University, Newcastle upon Tyne, UK
Scott Wilkes
12 School of Medicine, University of Sunderland, Sunderland, UK
David Cohen
Northwick Park, London North West University Healthcare NHS Trust, Harrow, UK
Laura Ternent
Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Tracy Finch
1 Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, UK
Lisa Shaw
Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
Richard Francis
The National Hospital of Neurology and Neurosurgery, Queen Square, London
Nina Wilson
Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
Cristina Fernandez-Garcia
Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Tara Marie Homer
Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Helen Bosomworth
Stroke Research Group, Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Lydia Aird
Stroke Northumbria, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
Sreeman Andole
Stroke Medicine, Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
Steven Hogg
(Lay Investigator) Contact Stroke Research Group, Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Niall Hughes
Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
H I Krebs
Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
Duncan Turner
School of Health Sport and Bioscience, University of East London, London, UK
Frederike Van Wijck
School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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.
