An Economic Analysis of Robot-Assisted Therapy for Long-Term Upper-Limb Impairment After Stroke

Abstract

Background and Purpose Stroke is a leading cause of disability. Rehabilitation robotics have been developed to aid in recovery after a stroke. This study determined the additional cost of robot-assisted therapy and tested its cost-effectiveness. Methods We estimated the intervention costs and tracked participants' healthcare costs. We collected quality of life using the Stroke Impact Scale and the Health Utilities Index. We analyzed the cost data at 36 weeks postrandomization using multivariate regression models controlling for site, presence of a prior stroke, and Veterans Affairs costs in the year before randomization. Results A total of 127 participants were randomized to usual care plus robot therapy (n=49), usual care plus intensive comparison therapy (n=50), or usual care alone (n=28). The average cost of delivering robot therapy and intensive comparison therapy was $5152 and $7382, respectively (P<0.001), and both were significantly more expensive than usual care alone (no additional intervention costs). At 36 weeks postrandomization, the total costs were comparable for the 3 groups ($17 831 for robot therapy, $19 746 for intensive comparison therapy, and $19 098 for usual care). Changes in quality of life were modest and not statistically different. Conclusions The added cost of delivering robot or intensive comparison therapy was recuperated by lower healthcare use costs compared with those in the usual care group. However, uncertainty remains about the cost-effectiveness of robotic-assisted rehabilitation compared with traditional rehabilitation. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT00372411.

Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

“…[110][111][112][113] However, because of the lack of high-quality evidence, both clinical and costeffectiveness, the benefits and risks of robotic, virtual reality, and gaming-based rehabilitation compared with conventional therapies remain unclear. [112][113][114][115] Large, welldesigned, multicenter studies evaluating the benefits and risks of robotic, virtual reality, and gaming therapy are clearly needed. Research that provides information on optimal dose, appropriate time to initiate such therapies, and criteria for identifying patients who will benefit most from such therapies is especially needed.…”

Perceptions of Existing Wearable Robotic Devices for Upper Extremity and Suggestions for Their Development: Findings From Therapists and People With Stroke (Preprint)

“…Users tend to make cost comparison between traditional therapy and any new technology for rehabilitation (like robotic rehabilitation), although there was no statistical significant difference between robotic rehabilitation cost and the usual care cost as reported by Wagner et al [30], where they compared the cost of delivering rehabilitation for three groups, first group received robotic rehabilitation, second group received use care and the third group received usual care plus intensive comparison therapy. Moreover, the clinical benefit or the effectiveness of devices is a complementary part to the cost-effectiveness trade-off, previous study by Demain et al [31] reported that the strength of clinical effectiveness as an important factor that impeded the translation of rehabilitation research into clinical practice and stressed on the urgent need for evidence from clinical settings to support assistive technology use in stroke upper-limb rehabilitation.…”

Rehabilitation: Machine recovery

“…A 2011 study 9 of the MIT-Manus showed that a 36-week course of robot-assisted therapy cost several thousand dollars less than the same duration of conventional therapy, even when the cost of the devices was taken into account.…”