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

• Type of Material: Article
• Authors: Edelle Field-Fote, Emory University; Daniel Pinto, Marquette University; Allen W Heinemann, Center for Rehabilitation Outcomes Research Chicago; Shuo-Hsiu Chang, TIRR Memorial Hermann; Susan Charlifue, Craig Hospital, Englewood; Catherine L Furbish, Shepherd Center, Atlanta; Arun Jayaraman, Max Näder Center for Rehabilitation Technologies and Outcomes Research and Outcomes Research; Candace Tefertiller, Craig Hospital; Heather B Taylor, TIRR Memorial Hermann; Dustin D French, Northwestern University
• Language: English
• Date: 2023-01-21
• Publisher: BMC
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s12984-023-01134-7
• Title of Journal or Parent Work: JOURNAL OF NEUROENGINEERING AND REHABILITATION
• Volume: 20
• Issue: 1
• Start Page: 10
• End Page: 10
• Grant/Funding Information: The National Institute on Disability, Independent Living, and Rehabilitation Research provided funding through the Midwest Regional SCI Model System (90SI5009), the Rocky Mountain Regional Spinal Injury System (90SI5015), the Southeastern Regional Spinal Cord Injury Model System at Shepherd Center (90SI5016), and the Texas Model Spinal Cord Injury System at TIRR Memorial Hermann (90SI5027).
• Keywords: Exoskeleton device; Engineering, Biomedical; Life Sciences & Biomedicine; Gait; Rehabilitation; Quality-adjusted life years; BODY-COMPOSITION; Neurosciences & Neurology; Spinal cord injuries; INDIVIDUALS; EXOSKELETAL-ASSISTED WALKING; HEALTH; TECHNOLOGY; Neurosciences; Technology; PRINCIPLES; Engineering; Science & Technology; Physical therapy modalities
• Research Categories: Health Sciences, Opthamology; Health Sciences, Rehabilitation and Therapy; Health Sciences, Medicine and Surgery

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.