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

被引：10

作者：

Fernandez-Garcia, Cristina ^{[1
]}

Ternent, Laura ^{[1
]}

Homer, Tara Marie ^{[1
]}

Rodgers, Helen ^{[2
,3
]}

Bosomworth, Helen ^{[2
]}

Shaw, Lisa ^{[2
]}

Aird, Lydia ^{[3
]}

Andole, Sreeman ^{[4
]}

Cohen, David ^{[5
]}

Dawson, Jesse ^{[6
]}

Finch, Tracy ^{[7
]}

Ford, Gary ^{[2
,8
]}

Francis, Richard ^{[1
]}

Hogg, Steven ^{[2
]}

Hughes, Niall ^{[9
]}

Krebs, H., I ^{[10
]}

Price, Christopher ^{[2
,3
]}

Turner, Duncan ^{[11
]}

Van Wijck, Frederike ^{[12
]}

Wilkes, Scott ^{[13
]}

Wilson, Nina ^{[1
]}

Vale, Luke ^{[1
]}

机构：

[1] Newcastle Univ, Populat Hlth Sci Inst, Fac Med Sci, Newcastle Upon Tyne, Tyne & Wear, England

[2] Newcastle Univ, Populat Hlth Sci Inst, Fac Med Sci, Stroke Res Grp, Newcastle Upon Tyne, Tyne & Wear, England

[3] Northumbria Healthcare NHS Fdn Trust, Stroke Northumbria, North Shields, England

[4] Barking Havering & Redbridge Hosp NHS Trust, Stroke Med, Romford, Essex, England

[5] London North West Univ Healthcare NHS Trust, Northwick Pk, Harrow, Middx, England

[6] Univ Glasgow, Inst Cardiovasc & Med Sci, Glasgow, Lanark, Scotland

[7] Northumbria Univ, Nursing Midwifery & Hlth, Newcastle Upon Tyne, Tyne & Wear, England

[8] Oxford Univ Hosp NHS Fdn Trust, Oxford Acad Hlth Sci Network, Oxford, England

[9] NHS Greater Glasgow & Clyde, Queen Elizabeth Univ Hosp, Glasgow, Lanark, Scotland

[10] MIT, Dept Mech Engn, Cambridge, MA 02139 USA

[11] Univ East London, Sch Hlth Sport & Biosci, London, England

[12] Glasgow Caledonian Univ, Sch Hlth & Life Sci, Glasgow, Lanark, Scotland

[13] Univ Sunderland, Sch Pharm, Sunderland, England

来源：

BMJ OPEN | 2021年 / 11卷 / 05期

关键词：

stroke medicine; rehabilitation medicine; stroke; health economics;

D O I：

10.1136/bmjopen-2020-042081

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

ObjectiveTo determine whether robot-assisted training is cost-effective compared with an enhanced upper limb therapy (EULT) programme or usual care. DesignEconomic evaluation within a randomised controlled trial. SettingFour 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. Participants770 participants aged 18 years or older with moderate or severe upper limb functional limitation from first-ever stroke. InterventionsParticipants 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 measuresMean 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. ResultsAt 6months, on average usual care was the least costly option (3785) followed by EULT (4451) with robot-assisted training being the most costly (5387) pound. The mean difference in total costs between the usual care and robot-assisted training groups (1601) pound 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 6months for participants randomised to EULT compared with usual care was 74100 pound. 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 20000 pound willingness to pay (WTP) threshold. Usual care was most likely to be cost-effective at all the WTP values considered in the analysis. ConclusionsThe 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 numberISRCTN69371850.

引用

页数：12

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