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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1083 — An Economic Analysis of Robot-Assisted Therapy for Long-Term Upper-Limb Impairment after Stroke

Wagner TH (VA Palo Alto), Lo A (Providence VA Medical Center), Peduzzi P (VA Connecticut Cooperative Studies Program Coordinating Center), Krebs HI (MIT), Bravata D (Durham VA Medical Center), Richards L (North Florida/South Georgia Veterans Health System), Haselkorn J (VA Puget Sound), Wittenberg G (Baltimore VA Medical Center), Federman D (VA Connecticut Health Care System), Guarino P (VA Connecticut Cooperative Studies Program Coordinating Center)

Objectives:
Stroke is the leading cause of disability, and 55-70% of survivors have a moderate or severe functional impairment. Robot-assisted devices have been developed to aid in the rehabilitation of stroke patients. A recent clinical trial showed that robot-assisted therapy can improve arm function compared to usual care. The aim of this study was to determine the cost of robot-assisted therapy and whether reductions in health care utilization would offset the robot's cost.

Methods:
We estimated the intervention costs and tracked participants’ VA health care use and costs using national VA databases through 36 weeks post randomization (the main outcome). We collected self-reported non-VA utilization, use of caregiver support, and quality of life. We analyzed the cost data using multivariate regression models while controlling for site, presence of a prior stroke, and VA costs in the year prior to randomization.

Results:
A total of 127 patients were randomized to usual care plus robot therapy (n = 49), usual care plus intensive comparison therapy (n = 50) and usual care alone (n = 28). The average cost of therapy was $9,492 and $8,004 for the robot and intensive comparison therapy, respectively; this difference was not statistically significant. The usual care group used the most health care, such that when we combined the intervention costs and health care costs, there were no cost differences across the groups. No significant quality of life differences were found.

Implications:
When intervention and health care costs were combined, the average cost of the robot group was $22,171 while the intensive comparison therapy groups and usual care groups were $20,368 and $19,098, respectively. There is some evidence that lower health care costs offset the cost of the robot therapy.

Impacts:
Health care decision makers should consider the size of the stroke population that will use the robot before deciding to invest in robot-assisted rehabilitative equipment. A high-volume facility could have three patients use the robot at the same time, and under these conditions the per-patient cost of robot therapy decreases from $9,294 to $6,878, although this does not lead to a statistically significant savings.


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