Cost-effectiveness analysis of overground robotic training versus conventional locomotor training in people with spinal cord injury

Abstract

Background Few, if any estimates of cost-effectiveness for locomotor training strategies following spinal cord injury (SCI) are available. The purpose of this study was to estimate the cost-effectiveness of locomotor training strategies following spinal cord injury (overground robotic locomotor training versus conventional locomotor training) by injury status (complete versus incomplete) using a practice-based cohort. Methods A probabilistic cost-effectiveness analysis was conducted using a prospective, practice-based cohort from four participating Spinal Cord Injury Model System sites. Conventional locomotor training strategies (conventional training) were compared to overground robotic locomotor training (overground robotic training). Conventional locomotor training included treadmill-based training with body weight support, overground training, and stationary robotic systems. The outcome measures included the calculation of quality adjusted life years (QALYs) using the EQ-5D and therapy costs. We estimate cost-effectiveness using the incremental cost utility ratio and present results on the cost-effectiveness plane and on cost-effectiveness acceptability curves. Results Participants in the prospective, practice-based cohort with complete EQ-5D data (n = 99) qualified for the analysis. Both conventional training and overground robotic training experienced an improvement in QALYs. Only people with incomplete SCI improved with conventional locomotor training, 0.045 (SD 0.28), and only people with complete SCI improved with overground robotic training, 0.097 (SD 0.20). Costs were lower for conventional training, $1758 (SD $1697) versus overground robotic training $3952 (SD $3989), and lower for those with incomplete versus complete injury. Conventional overground training was more effective and cost less than robotic therapy for people with incomplete SCI. Overground robotic training was more effective and cost more than conventional training for people with complete SCI. The incremental cost utility ratio for overground robotic training for people with complete spinal cord injury was $12,353/QALY. Conclusions The most cost-effective locomotor training strategy for people with SCI differed based on injury completeness. Conventional training was more cost-effective than overground robotic training for people with incomplete SCI. Overground robotic training was more cost-effective than conventional training for people with complete SCI. The effect estimates may be subject to limitations associated with small sample sizes and practice-based evidence methodology. These estimates provide a baseline for future research.

Economic Cost of Rehabilitation with Robotic and Virtual Reality Systems in People with Neurological Disorders: A Systematic Review

“…A total of 23 records were assessed for eligibility, with 8 being excluded for different reasons (conference papers and studied diseases other than neurological disorders). Finally, 15 studies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] were included in the systematic review and were appraised for quality ( Figure 1 ).…”

“…A total of 15 studies with 1634 patients were included in this review (1108 individuals who experienced a stroke and 99 with a spinal cord injury for robotic studies; 367 people who experienced a stroke, 30 with multiple sclerosis and 30 with cerebral palsy for virtual reality studies). Ten papers were focused on robotics [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and five on virtual reality [ 28 , 29 , 30 , 31 , 32 ] ( Figure 2 ). The studies showed a greater predominance of men than women.…”

“…Regarding the papers focused on robotics, nine records recruited people who experienced a stroke [ 18 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ] and one record recruited people with an SCI [ 19 ]. Six studies employed robots for upper-limb rehabilitation [ 18 , 20 , 21 , 22 , 25 , 26 ], two for lower-limb rehabilitation [ 24 , 27 ], and two for upper- and lower-limb rehabilitation [ 19 , 23 ]. Two papers [ 18 , 19 ] used a combination of robots for their aims.…”

“…Patients were recruited in different phases of stroke recovery (subacute and chronic phases), with a greater predominance of chronic patients. Patients with a spinal cord injury (SCI) were recruited in the acute and chronic phases [ 27 ]. There was no description of the Expanded Disability Status Scale (EDSS) for the recruited multiple sclerosis patients [ 31 ].…”

“…The studies came from various countries ( Figure 4 ), namely the United States of America [ 20 , 21 , 23 , 27 ], Mexico [ 19 ], Spain [ 28 ], Germany [ 18 ], Italy [ 22 ], Denmark, Norway and Belgium (a multicentric international study) [ 29 ], the United Kingdom [ 25 , 26 , 30 , 31 , 32 ] and China [ 24 ].…”